Nephrol Dial Transplant (2004) 19: 686-691
Nephrol Dial Transplant Vol. 19 No. 3 (c) ERA-EDTA 2004; all rights reserved
Original Article
Death after withdrawal from dialysis: the most common cause of death in a French dialysis population
1Néphrologie–Immunologie Clinique, CHRU Bretonneau, Tours, 2Centre de dialyse, Clinique Maison Blanche, Vernouillet, 3Centre de Néphrologie, Châteauroux, 4Néphrologie, CHG, Bourges, 5Centre d’hémodialyse, Clinique Saint Côme et Saint Damien, Blois, 6Service de néphrologie, CHR, Orléans, 7Centre d’Hémodialyse de l’Archette, Olivet, 8Clinique d’hémodialyse Jeanne d’Arc, Gien, 9ARAUCO, Tours, 10Service de Néphrologie, CH, Chartres and 11AIRBP, Chartres, France
Correspondence and offprint requests to: Béatrice Birmele, Néphrologie–Immunologie Clinique, CHRU Bretonneau, 2 boulevard Tonnellé, F-37044 Tours, France. Email: b.birmele{at}chu-tours.fr
Background. Discontinuation of dialysis is a common cause of death in end-stage renal disease (ESRD) patients in North America and the UK, but appears to be unusual in the rest of Europe. The aim of this retrospective study was to characterize withdrawal from dialysis in a French population cohort.
Methods. We assessed the cause of death, and the medical and social characteristics of chronic dialysis patients in a French population who died in 2001. We compared patients who died after withdrawal from dialysis and patients continuing dialysis until death. We determined the decision-making process when dialysis was withdrawn.
Results. In a population cohort of 1436 dialysis patients, 196 died (13.9%). Of them, 40 patients (20.4%) died following withdrawal from dialysis. This was the most common cause of death, followed by cardio-vascular disease (18.4%). Patients withdrawing from dialysis had a significantly higher rate of dementia (17.5 vs 6.4%, P = 0.02), a poor general condition (55 vs 15.4%, P < 0.001), and were dependent in their life for everyday activities in comparison with patients who died from other causes. They were not different in age, sex, duration of dialysis treatment, dialysis technique, cardio-vascular disease, diabetes, stroke or cancer, but the sample size was small. Treatment was more often removed in patients with severe medical complications and/or cachexia (90%). The decision to stop dialysis was made most often by a physician (77.5%).
Conclusion. Death after withdrawing from dialysis was the most common cause of death in ESRD patients in our French population cohort. The patients who died after discontinuation of treatment were more often in a poor general condition, near the end of life, and most often the physician decided to stop dialysis treatment.
Keywords: end of life; end-stage renal disease; epidemiology; withdrawal from dialysis
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