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Temporal changes and risk factors for death from early withdrawal within 12 months of dialysis initiation—a cohort study

Chen, JHC, Brown, MA, Jose, M ORCID: 0000-0002-9589-0071, Brennan, F, Johnson, DW, Roberts, MA, Wong, G, Cheikh Hassan, H, Kennard, A, Walker, R, Davies, CE, Boudville, N, Borlace, M, Hawley, C and Lim, WH 2021 , 'Temporal changes and risk factors for death from early withdrawal within 12 months of dialysis initiation—a cohort study' , Nephrology, Dialysis and Transplantation , pp. 1-10 , doi: https://doi.org/10.1093/ndt/gfab207.

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Abstract

Background: Mortality risk is high soon after dialysis initiation in patients with kidney failure, and dialysis withdrawal is a major cause of early mortality, attributed to psychosocial or medical reasons. The temporal trends and risk factors associated with cause-specific early dialysis withdrawal within 12 months of dialysis initiation remain uncertain.Methods: Using data from the Australia and New Zealand Dialysis and Transplant Registry, we examined the temporal trends and risk factors associated with mortality attributed to early psychosocial and medical withdrawals in incident adult dialysis patients in Australia between 2005 and 2018 using adjusted competing risk analyses.Results: Of 32 274 incident dialysis patients, 3390 (11%) experienced death within 12 months post-dialysis initiation. Of these, 1225 (36%) were attributed to dialysis withdrawal, with 484 (14%) psychosocial withdrawals and 741 (22%) medical withdrawals. These patterns remained unchanged over the past two decades. Factors associated with increased risk of death from early psychosocial and medical withdrawals were older age, dialysis via central venous catheter, late referral and the presence of cerebrovascular disease; obesity and Asian ethnicity were associated with decreased risk. Risk factors associated with early psychosocial withdrawals were underweight and higher socioeconomic status. Presence of peripheral vascular disease, chronic lung disease and cancers were associated with early medical withdrawals.

Item Type: Article
Authors/Creators:Chen, JHC and Brown, MA and Jose, M and Brennan, F and Johnson, DW and Roberts, MA and Wong, G and Cheikh Hassan, H and Kennard, A and Walker, R and Davies, CE and Boudville, N and Borlace, M and Hawley, C and Lim, WH
Keywords: dialysis, frailty, kidney supportive care, mortality, treatment withdrawal, chronic kidney disease, end-stage kidney disease, transplant
Journal or Publication Title: Nephrology, Dialysis and Transplantation
Publisher: Oxford Univ Press
ISSN: 0931-0509
DOI / ID Number: https://doi.org/10.1093/ndt/gfab207
Copyright Information:

Copyright 2021 The Author(s)Licensed under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)https://creativecommons.org/licenses/by-nc/4.0/

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