Dying Well After Discontinuing the Life-Support Treatment of Dialysis

Cohen, Lewis M.; Germain, Michael J.; Poppel, David M.; Woods, Anne; Pekow, Penelope S.; Kjellstrand, Carl M.

doi:10.1001/archinte.160.16.2513

Cited by 91 publications

(83 citation statements)

References 34 publications

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“…Exceptions are the Baystate Dialysis Discontinuation Study (Cohen, Germain, Poppel, Woods, Pekow, & Kjellstrand, 2000), and a recent study of dialysis abatement in Melbourne, Australia (Ashby, op't Hoog, Kellehear, Kerr, Brooks, Nicholls, & Forrest, 2005).…”

Section: The Emergence Of Geriatric Dialysismentioning

confidence: 99%

The value of “life at any cost”: Talk about stopping kidney dialysis

Russ

Shim

Kaufman

2007

Social Science & Medicine

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With the trend toward an older, sicker dialysis population in the USA, discussions of ethical issues surrounding dialysis have shifted from concerns about access to and availability of the therapy, to growing unease about non-initiation and treatment discontinuation. Recent studies report treatment withdrawal as the leading cause of death among elderly dialysis patients. Yet, the actual activities that move patients toward stopping treatment often remain obscure, even to clinicians and patients themselves. This paper explores that paradox, drawing on anthropological research among patients over age 70, their families, and clinicians in two California renal dialysis units. It concludes that many older patients sacrifice a sense of choice about dialysis in the present to maintain "choice" as both value and possibility for the future. Yet, patients desire more information and communication, provided earlier in their illness, about prognosis, how long they can expect to be on dialysis, and what the impact of the treatment will be on their daily lives. That, with time, there is a transition to be made from dialysis as "treatment" to end of life care could be better explained and managed to alleviate patients' confusion and unneeded isolation.

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Section: The Emergence Of Geriatric Dialysismentioning

confidence: 99%

The value of “life at any cost”: Talk about stopping kidney dialysis

Russ

Shim

Kaufman

2007

Social Science & Medicine

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“…For instance, two cohort studies reported a mean survival of 8 days from the last dialysis session, but both also described a large range in actual survival (1-46 days) (7,8). A third cohort study reported average survival of 12 days with an even wider range (1-150 days) (9).…”

Section: Introductionmentioning

confidence: 99%

Survival after Dialysis Discontinuation and Hospice Enrollment for ESRD

O’Connor

Dougherty

Harris

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Textbooks report that patients with ESRD survive for 7-10 days after discontinuation of dialysis. Studies describing actual survival are limited, however, and research has not defined patient characteristics that may be associated with longer or shorter survival times. The goals of this study were to determine the mean life expectancy of patients admitted to hospice after discontinuation of dialysis, and to identify independent predictors of survival time.Design, setting, participants, & measurements Data for demographics, clinical characteristics, and survival were obtained from 10 hospices for patients with ESRD who discontinued dialysis before hospice admission. Data were collected for patients admitted between January 1, 2008 and May 15, 2012. All hospices were members of the Coalition of Hospices Organized to Investigate Comparative Effectiveness network, which obtains de-identified data from an electronic medical record.Results Of 1947 patients who discontinued dialysis, the mean survival after hospice enrollment was 7.4 days (range, 0-40 days). Patients who discontinued dialysis had significantly shorter survival compared with other patients (n=124,673) with nonrenal hospice diagnoses (mean survival 54.4 days; hazard ratio, 2.96; 95% confidence interval, 2.82 to 3.09; P,0.001). A Cox proportional hazards model identified seven independent predictors of earlier mortality after dialysis discontinuation, including male sex, referral from a hospital, lower functional status (Palliative Performance Scale score), and the presence of peripheral edema.Conclusions Patients who discontinue dialysis have significantly shorter survival than other hospice patients. Individual survival time varies greatly, but several variables can be used to predict survival and tailor a patient's care plan based on estimated prognosis.

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“…Buchwald's experience also illustrates the large degree of uncertainty that often exists about prognosis, future illness trajectory, and optimal approaches to treatment for patients with advanced kidney disease (16). That Buchwald survived for 11 months after discontinuing dialysis raises the question of whether he really "needed" this treatment in the first place.…”

mentioning

confidence: 99%