title: Risk factors for dialysis withdrawal: an analysis of the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, 1999-2008.
abstract: OBJECTIVE
  Dialysis withdrawal (DW) in patients with ESRD is increasing in importance. This study assessed causes of death and risk factors for DW in Australia and New Zealand in the first year of dialysis.
  
  
  METHODS
  This retrospective observational cohort study included all adult Australians and New Zealanders beginning renal replacement therapy in 1999-2008.
  
  
  RESULTS
  A total of 24,884 patients with 10,073 deaths were included. Deaths from cardiac and social causes (predominantly DW) accounted for 38% and 28% of all deaths, respectively. Cumulative incidence of DW was 3.5% at 1 year (95% confidence interval [CI], 3.3%-3.8%), 9.0% at 3 years (95% CI, 8.6%-9.4%), and 13.4% at 5 years (95% CI, 12.8%-13.9%). In multivariate analysis, predictors for DW in the first year were older age (subhazard ratio [SHR], 1.70 per decade [95% CI, 1.59-1.83]; P<0.001), late referral (SHR, 1.83 [95% CI, 1.59-2.11]; P<0.001), comorbid conditions (SHR, 1.33 per each additional comorbid condition [95% CI, 1.25-1.41]; P<0.001), and diabetes (SHR, 1.16 [95% CI, 1.00-1.34]; P=0.05). Negative predictors for DW included male sex (SHR, 0.75 [95% CI, 0.66-0.87]; P<0.001), indigenous ethnicity (SHR, 0.74 [95% CI, 0.58-0.95]; P=0.02), other nonwhite race (SHR, 0.66 [95% CI, 0.48-0.91]; P=0.01), and peritoneal dialysis user (SHR, 0.59 [95% CI, 0.49-0.72]; P<0.001).
  
  
  CONCLUSIONS
  DW is common among dialysis patients in Australia and New Zealand. Risk factors include older age, female sex, white race, diabetes, higher comorbidity burden, hemodialysis user, and late referral to nephrologist.
authors.affiliation: Renal Unit, Queen Elizabeth Hospital, Hong Kong. jenhw_chan@yahoo.com
authors.forename: Hoi Wong
authors.initials: HW
authors.lastname: Chan
authors.forename: Philip A
authors.initials: PA
authors.lastname: Clayton
authors.forename: Stephen P
authors.initials: SP
authors.lastname: McDonald
authors.forename: John W M
authors.initials: JW
authors.lastname: Agar
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Jose
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data; D001315:Australia / Q000453:epidemiology; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality*; D005260:Female; D006331:Heart Diseases / Q000401:mortality*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009520:New Zealand / Q000453:epidemiology; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012042:Registries; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D044465:White People / Q000706:statistics & numerical data; D028761:Withholding Treatment / Q000706:statistics & numerical data*