ArticleNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2021
Dialysis withdrawal in The Netherlands between 2000 and 2019: time trends, risk factors and centre variation.
Article in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 16 citations in OpenAlex.
- Position statement of the Brazilian Society of Nephrology on the refusal and discontinuation of dialysis.Jornal brasileiro de nefrologiaGuideline
- Ten tips for the first hemodialysis sessions.Clinical kidney journal · 2026Review
- Sex and Cause-Specific Mortality among US Adults Receiving Maintenance Dialysis: National US Cohort Study 2000-2021.Kidney360 · 2025Article
- Dialysis Discontinuation, Prognosis, and Shared Decision-Making.Kidney international reports · 2024Article
- Prognostication After Dialysis Withdrawal.Kidney international reports · 2024Article
- Using Relative Survival to Estimate the Burden of Kidney Failure.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2024Article
- A review of supportive care for older people with advanced chronic kidney disease.Clinical kidney journal · 2023Review
- Changing landscape of dialysis withdrawal in patients with kidney failure: Implications for clinical practice.Nephrology (Carlton, Vic.) · 2022Review
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Authors and funding
7 authors at 6 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDialysis withdrawal is a common cause of death in dialysis-dependent patients. This study aims to describe dialysis withdrawal practice in The Netherlands, focussing on time trends, risk factors and centre variation.
methodsData were retrieved from the Dutch registry of kidney replacement therapy patients. All patients who started maintenance dialysis and died in the period 2000-2019 were included. The main outcome was death after dialysis withdrawal; all other causes of death were used for comparison. Time trends were analysed as unadjusted data (proportion per year) and the year of death was included in a multivariable logistic model. Univariable and multivariable analyses were performed to identify factors associated with withdrawal. Centre variation was compared using funnel plots.
resultsA total of 34 692 patients started dialysis and 18 412 patients died while on dialysis. Dialysis withdrawal was an increasingly common cause of death, increasing from 18.3% in 2000-2004 to 26.8% in 2015-2019. Of all patients withdrawing, 26.1% discontinued treatment within their first year. In multivariable analysis, increasing age, female sex, haemodialysis as a treatment modality and year of death were independent factors associated with death after dialysis withdrawal. Centre variation was large (80.7 and 57.4% within 95% control limits of the funnel plots for 2000-2009 and 2010-2019, respectively), even after adjustment for confounding factors.
conclusionsTreatment withdrawal has become the main cause of death among dialysis-dependent patients in The Netherlands, with large variations between centres. These findings emphasize the need for timely advance care planning and improving the shared decision-making process on choosing dialysis or conservative care.
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