TY - JOUR
T1 - Dialysis withdrawal in the Netherlands between 2000 and 2019
T2 - Time trends, risk factors and centre variation
AU - van Oevelen, Mathijs
AU - Abrahams, Alferso C.
AU - Bos, Willem Jan W.
AU - Hoekstra, Tiny
AU - Hemmelder, Marc H.
AU - ten Dam, Marc
AU - van Buren, Marjolijn
N1 - Publisher Copyright: © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of ERA-EDTA.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Background: Dialysis withdrawal is a common cause of death in dialysis-dependent patients. This study aims to describe dialysis withdrawal practice in The Netherlands, focussing on time trends, risk factors and centre variation. Methods: Data were retrieved from the Dutch registry of kidney replacement therapy patients. All patients who started maintenance dialysis and died in the period 2000-2019 were included. The main outcome was death after dialysis withdrawal; all other causes of death were used for comparison. Time trends were analysed as unadjusted data (proportion per year) and the year of death was included in a multivariable logistic model. Univariable and multivariable analyses were performed to identify factors associated with withdrawal. Centre variation was compared using funnel plots. Results: A total of 34 692 patients started dialysis and 18 412 patients died while on dialysis. Dialysis withdrawal was an increasingly common cause of death, increasing from 18.3% in 2000-2004 to 26.8% in 2015-2019. Of all patients withdrawing, 26.1% discontinued treatment within their first year. In multivariable analysis, increasing age, female sex, haemodialysis as a treatment modality and year of death were independent factors associated with death after dialysis withdrawal. Centre variation was large (80.7 and 57.4% within 95% control limits of the funnel plots for 2000-2009 and 2010-2019, respectively), even after adjustment for confounding factors. Conclusions: Treatment withdrawal has become the main cause of death among dialysis-dependent patients in The Netherlands, with large variations between centres. These findings emphasize the need for timely advance care planning and improving the shared decision-making process on choosing dialysis or conservative care.
AB - Background: Dialysis withdrawal is a common cause of death in dialysis-dependent patients. This study aims to describe dialysis withdrawal practice in The Netherlands, focussing on time trends, risk factors and centre variation. Methods: Data were retrieved from the Dutch registry of kidney replacement therapy patients. All patients who started maintenance dialysis and died in the period 2000-2019 were included. The main outcome was death after dialysis withdrawal; all other causes of death were used for comparison. Time trends were analysed as unadjusted data (proportion per year) and the year of death was included in a multivariable logistic model. Univariable and multivariable analyses were performed to identify factors associated with withdrawal. Centre variation was compared using funnel plots. Results: A total of 34 692 patients started dialysis and 18 412 patients died while on dialysis. Dialysis withdrawal was an increasingly common cause of death, increasing from 18.3% in 2000-2004 to 26.8% in 2015-2019. Of all patients withdrawing, 26.1% discontinued treatment within their first year. In multivariable analysis, increasing age, female sex, haemodialysis as a treatment modality and year of death were independent factors associated with death after dialysis withdrawal. Centre variation was large (80.7 and 57.4% within 95% control limits of the funnel plots for 2000-2009 and 2010-2019, respectively), even after adjustment for confounding factors. Conclusions: Treatment withdrawal has become the main cause of death among dialysis-dependent patients in The Netherlands, with large variations between centres. These findings emphasize the need for timely advance care planning and improving the shared decision-making process on choosing dialysis or conservative care.
KW - advance care planning
KW - end of life
KW - end-stage renal disease
KW - kidney failure
KW - mortality
UR - http://www.scopus.com/inward/record.url?scp=85121275427&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/ndt/gfab244
DO - https://doi.org/10.1093/ndt/gfab244
M3 - Article
C2 - 34390576
SN - 0931-0509
VL - 36
SP - 2112
EP - 2119
JO - Nephrology dialysis transplantation
JF - Nephrology dialysis transplantation
IS - 11
ER -