+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
EurekaMag Most Shared ContentMost Shared
EurekaMag PDF Full Text ContentPDF Full Text
+ PDF Full Text
Request PDF Full TextRequest PDF Full Text
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter
Follow on LinkedInFollow on LinkedIn

+ Translate

Early dialysis initiation and rates and timing of withdrawal from dialysis in Canada

Early dialysis initiation and rates and timing of withdrawal from dialysis in Canada

Clinical Journal of the American Society of Nephrology 8(2): 265-270

The number of elderly patients and those with higher estimated GFR (eGFR) initiating dialysis have recently increased. This study sought to determine rates of withdrawal from dialysis and variables associated with withdrawal. Canadian Organ Replacement Registry data were used to examine withdrawal rate and identify variables associated with withdrawal among the total cohort, patients age < 75 years, and patients age ≥ 75 years, along with those with early (eGFR > 10.5 ml/min per 1.73 m(2)) and those with late (eGFR ≤ 10.5 ml/min per 1.73 m(2)) initiation of dialysis, using a Cox proportional hazard model in patients starting dialysis between 2001 and 2009, with follow-up to December 31, 2009. Median follow-up duration was 23.0 (interquartile range [IQR], 34.3) months. Rate of withdrawal per 100 patient-years doubled from 1.5 to 3.0, and withdrawal as cause of death increased from 7.9% to 19.5% between 2001 and 2009. Early initiation of dialysis was associated with increased withdrawal risk (hazard ratio, 1.17; 95% confidence interval, 1.06-1.30; P=0.002), as were older age, female sex, white race, and late referral to nephrologist. Patients age ≥ 75 years withdrew earlier after dialysis initiation (median, 15.9 [IQR, 27.9] months) compared to those age < 75 years (21.6 [IQR, 35.2] months). Early-start patients withdrew earlier (median, 15.6 [IQR, 28.5] months) compared with late-start patients (20.2 [IQR, 32.9] months). In Canada, withdrawal from dialysis has increased significantly over recent years, especially among patients starting with higher eGFRs and in the elderly.

(PDF emailed within 0-6 h: $19.90)

Accession: 052757625

Download citation: RISBibTeXText

PMID: 23085725

DOI: 10.2215/CJN.01000112

Related references

An assessment of dialysis provider's attitudes towards timing of dialysis initiation in Canada. Canadian Journal of Kidney Health and Disease 1(): 3-3, 2014

Ideal timing and predialysis nephrology care duration for dialysis initiation: from analysis of Japanese dialysis initiation survey. Therapeutic Apheresis and Dialysis 16(1): 54-62, 2012

The Impact of Timing of Dialysis Initiation on Mortality in Patients with Peritoneal Dialysis. Peritoneal Dialysis International 35(7): 703-711, 2016

Timing of dialysis initiation Diagnostic accuracy of estimates of renal function in pre-dialysis patients. Journal of the American Society of Nephrology 12(Program and Abstract Issue): 334A, September, 2001

Perceptions of pediatric nephrologists regarding timing of dialysis initiation in children in Canada. Canadian Journal of Kidney Health and Disease 3(): 31-31, 2016

Effect of timing of dialysis commencement on clinical outcomes of patients with planned initiation of peritoneal dialysis in the IDEAL trial. Peritoneal Dialysis International 32(6): 595-604, 2013

What drives early dialysis initiation and how do we optimize timing of RRT?. Clinical Journal of the American Society of Nephrology 9(10): 1671-1673, 2015

Early Nephrology Referral 6 Months Before Dialysis Initiation Can Reduce Early Death But Does Not Improve Long-Term Cardiovascular Outcome on Dialysis. Circulation Journal 80(4): 1008-1016, 2016

Comparative effectiveness of early versus conventional timing of dialysis initiation in advanced CKD. American Journal of Kidney Diseases 63(5): 806-815, 2014

Optimal point of time for initiation of dialysis. IDEAL Study (Initiating Dialysis EArly and Late). Der Internist 52(3): 336-338, 2011

The role of hemodialysis and peritoneal dialysis for the early initiation of dialysis. Blood Purification 19(2): 175-178, 2001

Early initiation of chronic dialysis: role of incremental dialysis. Peritoneal Dialysis International 17(5): 426-430, 1997

Early initiation of dialysis and late implantation of catheters adversely affect outcomes of patients on chronic peritoneal dialysis. Peritoneal Dialysis International 28(1): 73-81, 2008

Withholding and withdrawing dialysis in the intensive care unit: benefits derived from consulting the renal physicians association/american society of nephrology clinical practice guideline, shared decision-making in the appropriate initiation of and withdrawal from dialysis. Clinical Journal of the American Society of Nephrology 3(2): 587-593, 2008

Trends in initiation of dialysis in an urban dialysis clinic in the United States: a long way from dialysis outcomes quality initiative guidelines. Advances in Peritoneal Dialysis. Conference on Peritoneal Dialysis 15: 138-143, 2000