21 YEAR MORTALITY IN A DIALYSIS UNIT - CHANGING EFFECT OF WITHDRAWAL FROM DIALYSIS

To characterize the factors affecting the decision to withdraw from di alysis, the authors compared patients withdrawing from dialysis (n = 6 2) with patients dying from all other causes (n = 242) over 21 years ( 1976-1996) in a single dialysis unit. Compared with those who died fro m other causes, patients who withdrew were older (67 +/- 11 vs 61 +/- 11 years); were more likely to have severe physical impairment (87% vs 62%) and severe restriction of activities of daily living (77% vs 46% ); and had higher frequencies of congestive heart failure (81% vs 62%) , myocardial infarction (60% vs 42%), peripheral vascular disease (71% vs 40%), and diabetes mellitus (66% vs 36%) (p less than or equal to 0.014). Dialysis modality; duration of dialysis; the degree of family support; index of disease severity; the use of tobacco, alcohol, or il licit drugs; and the frequency of ischemic heart disease, dysrhythmia, pericarditis, cardiac arrest, cerebrovascular accident, hypertension, obstructive lung disease, cancer, and human immunodeficiency virus di d not differ between the two groups. Stepwise logistic regression show ed that dialysis during 1990-1996, severe limitation of activities of daily living, and diabetes mellitus were independent risk factors for withdrawal. During 1990-1996, 44% of the deaths were caused by withdra wal from treatment. In addition to other factors, dialysis in the 1990 s is a strong predictor of withdrawal from dialysis. The reasons for t he increased rate of withdrawal from dialysis in recent years, and the effect of this increased rate of withdrawal on mortality, need furthe r evaluation.