Early Dialysis Withdrawal on the Rise
Withdrawal rates are highest in the first few months after dialysis initiation.
SAN DIEGO— Rates of early withdrawal from dialysis are increasing, according to a study presented at Kidney Week 2015.
Using the Centers for Medicare & Medicare Services End-Stage Renal Disease database, James B. Wetmore, MD, of Hennepin County Medical Center in Minneapolis, Minn., and colleagues from the Peer Kidney Care Initiative analyzed dialysis withdrawal trends among patients initiating dialysis from 2004 to 2011. Early withdrawal rates more than tripled during the study period, from 1.9 per 100 patient-years at month 2 in 2004 to 6.4 per 100 patient-years in 2011.
Results also showed that during the first year of dialysis the withdrawal rate was highest soon after initiation, generally peaking at month 2 for all years except 2004, according to the investigators. Rates then decreased until about month 9 and stabilized through month 12.
“Withdrawal rates are highest in the first few months after dialysis initiation, which brings up the possibility that patients are being placed on dialysis who might not be best served by initiating dialysis,” Dr. Wetmore told Renal & Urology News. “This trend appears to have become common in recent years, a phenomenon which should be frankly debated by patients, providers, and the nephrology community as a whole.”
The investigators noted that voluntary withdrawal from dialysis often occurs when a patient perceives that dialysis has become unduly burdensome.