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

Background and objectivesThe 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.Design, setting, participants, & measurementsCanadian Organ Replacement Registry data were used to examine withdrawal rate and identify variables associated with withdrawal among the total cohort, patients age 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.ResultsMedian 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 ConclusionsIn Canada, withdrawal from dialysis has increased significantly over recent years, especially among patients starting with higher eGFRs and in the elderly.