Wetmore JB, et al. - The factors associated with withdrawal from dialysis therapy were searched in a population of US patients with Medicare coverage who received maintenance hemodialysis for 1 year or longer. The likelihood to withdraw from dialysis therapy was seen more among women, older patients, and those of white race. In addition, higher rates of medical events and higher levels of morbidity characterized the period before withdrawal.

• This case-control analysis was performed in US patients with Medicare coverage who received maintenance hemodialysis for 1 year or longer in 2008 through 2011.
• Comorbid conditions, hospitalizations, skilled nursing facility stays, and a morbidity score based on durable medical equipment claims were included as predictors.
• Outcome was withdrawal from dialysis therapy.
• Measurements included rates of medical events, hospitalizations, skilled nursing facility stays, and a morbidity score.

• A total of 18,367 (7.7%) patients who withdrew and 220,443 (92.3%) who did not, were included.
• Researchers noted that patients who withdrew were older (mean age, 75.3 ± 11.5 [SD] vs 66.2 ± 14.1 years) and more likely to be women and of white race, and had higher comorbid condition burdens.
• They also found 7% (95% CI, 4%-11%) higher odds of withdrawal among women (95% CI, 4%-11%) vs men.
• Findings demonstrated that relative to age 65 to 74 years, age 85 years or older was associated with higher adjusted odds of withdrawal (adjusted OR, 1.61; 95% CI, 1.54-1.68), and age 18 to 44 years with lower adjusted odds (adjusted OR, 0.36; 95% CI, 0.32-0.40).
• Less likelihood of withdrawal was reported for Blacks, Asians, and Hispanics than whites (adjusted ORs of 0.36 [95% CI, 0.35-0.38], 0.47 [95% CI, 0.42-0.53], and 0.46 [95% CI, 0.44-0.49], respectively).
• In addition, data revealed that even after adjustment for traditional comorbid conditions and hospitalization, a higher durable medical equipment claims-based morbidity score was associated with withdrawal; compared to a score of 0 (lowest presumed morbidity), adjusted ORs of withdrawal were 3.48 (95% CI, 3.29-3.67) for a score of 3 to 4 and 12.10 (95% CI, 11.37-12.87) for a score ≥7.
• Results showed that rates of medical events and institutionalization tended to increase in the months preceding withdrawal, as did morbidity score.