title: Death after withdrawal from dialysis: the most common cause of death in a French dialysis population.
abstract: 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 We determined the decision-making process when dialysis was withdrawn.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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Néphrologie-Immunologie Clinique, CHRU Bretonneau, Tours, France. b.birmele@chu-tours.fr
authors.forename: Béatrice
authors.initials: B
authors.lastname: Birmelé
authors.forename: Maud
authors.initials: M
authors.lastname: François
authors.forename: Josette
authors.initials: J
authors.lastname: Pengloan
authors.forename: Patrick
authors.initials: P
authors.lastname: Français
authors.forename: Didier
authors.initials: D
authors.lastname: Testou
authors.forename: Georges
authors.initials: G
authors.lastname: Brillet
authors.forename: Didier
authors.initials: D
authors.lastname: Lechapois
authors.forename: Serge
authors.initials: S
authors.lastname: Baudin
authors.forename: Olivier
authors.initials: O
authors.lastname: Grezard
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Jourdan
authors.forename: Mohamed
authors.initials: M
authors.lastname: Fodil-Cherif
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abaza
authors.forename: Luc
authors.initials: L
authors.lastname: Dupouet
authors.forename: Gilles
authors.initials: G
authors.lastname: Fournier
authors.forename: Hubert
authors.initials: H
authors.lastname: Nivet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D005602:France / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D012924:Social Conditions; D016896:Treatment Outcome; D028761:Withholding Treatment