Abstract: TH-PO281
Association of Illness and Disability with Elective Withdrawal in Hemodialysis
Session Information
- Hemodialysis and Frequent Dialysis - II
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Wetmore, James B., Hennepin County Medical Center, Minneapolis, Minnesota, United States
- Yan, Heng, Chronic Disease Research Group, Minneapolis, Minnesota, United States
- Gilbertson, David T., Chronic Disease Research Group, Minneapolis, Minnesota, United States
- Liu, Jiannong, Minneapolis Medical Research Foundation, Minneapolis, Minnesota, United States
Background
Few studies have contrasted elective withdrawal with non-withdrawal death by examining factors immediately prior to death.
Methods
Using USRDS data, we performed a retrospective analysis of hemodialysis patients who died 2010-2015. Deaths were divided into withdrawal versus non-withdrawal. A claims-based disability proxy score was used to characterize disability. Logistic regression was used to identify characteristics associated with type of death and death setting. Trajectory models were used to characterize trajectories of medical illness and disability prior to death. Factors associated with in-hospital death were examined.
Results
We identified 14,571 (9.2%) patients who withdrew and 144,305 (90.8%) who died of a non-withdrawal cause. Women were more likely to withdraw (odds ratio [OR] 1.19, 95% confidence interval 1.15-1.24). The most rural patients were more likely to withdraw than the most urban ones (OR 1.37, 1.25-1.50). Medicaid coverage (a marker for impoverishment) was associated with less withdrawal (OR 0.90, 0.86-0.94). Disability proxy score was strongly related to withdrawal: the OR for patients in the highest disability score category was 31.16 (28.40-34.20), vs. a score of 0. While trajectories of traditional medical events did not appear to differ between those who withdrew and those who otherwise died, the trajectory of the disbility score was markedly worse for those who withdrew (Figure). Women and whites (as opposed to blacks) were relatively over-represented in the worse, as opposed to better, trajectory of proxy disability score. In-hospital death was more common in women and minorities than in men and whites, but less common in rural patients.
Conclusion
Worsening disability may be a particularly important marker for elective dialysis withdrawal.
NW, non-withdrawer; W, withdrawer.
Funding
- NIDDK Support