Chan, HW and Clayton, PA and McDonald, SP and Agar, JWM and Jose, MD, Risk factors for dialysis withdrawal: an analysis of the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, 1999-2008, Clinical Journal of the American Society of Nephrology, 7, (5) pp. 775-781. ISSN 1555-9041 (2012) [Refereed Article]
Copyright 2012 by the American Society of Nephrology
Background and objectives: Dialysis withdrawal (DW) in patients with ESRD is increasing in importance. This study assessed causes of death and risk factors for DW in Australia and New Zealand in the first year of dialysis.
Design, setting, participants, & measurements: This retrospective observational cohort study included all adult Australians and New Zealanders beginning renal replacement therapy in 1999–2008.
Results: A total of 24,884 patients with 10,073 deaths were included. Deaths from cardiac and social causes (predominantly DW) accounted for 38% and 28% of all deaths, respectively. Cumulative incidence of DW was 3.5% at 1 year (95% confidence interval [CI], 3.3%–3.8%), 9.0% at 3 years (95% CI, 8.6%–9.4%), and 13.4% at 5 years (95% CI, 12.8%–13.9%). In multivariate analysis, predictors for DW in the first year were older age (subhazard ratio [SHR], 1.70 per decade [95% CI, 1.59–1.83]; P < 0.001), late referral (SHR, 1.83 [95% CI, 1.59–2.11]; P < 0.001), comorbid conditions (SHR, 1.33 per each additional comorbid condition [95% CI, 1.25–1.41]; P < 0.001), and diabetes (SHR, 1.16 [95% CI, 1.00–1.34]; P = 0.05). Negative predictors for DW included male sex (SHR, 0.75 [95% CI, 0.66–0.87]; P < 0.001), indigenous ethnicity (SHR, 0.74 [95% CI, 0.58–0.95]; P = 0.02), other nonwhite race (SHR, 0.66 [95% CI, 0.48–0.91]; P = 0.01), and peritoneal dialysis user (SHR, 0.59 [95% CI, 0.49–0.72]; P < 0.001).
Conclusions: DW is common among dialysis patients in Australia and New Zealand. Risk factors include older age, female sex, white race, diabetes, higher comorbidity burden, hemodialysis user, and late referral to nephrologist.
|Item Type:||Refereed Article|
|Research Division:||Biomedical and Clinical Sciences|
|Research Group:||Clinical sciences|
|Research Field:||Nephrology and urology|
|Objective Group:||Clinical health|
|Objective Field:||Clinical health not elsewhere classified|
|UTAS Author:||Chan, HW (Dr Hoi Chan)|
|UTAS Author:||Jose, MD (Professor Matthew Jose)|
|Web of Science® Times Cited:||27|
|Deposited By:||Menzies Institute for Medical Research|
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