title: Early dialysis initiation and rates and timing of withdrawal from dialysis in Canada.
abstract: OBJECTIVE
  The number of elderly patients and those with higher estimated GFR (eGFR) initiating dialysis have recently increased. This study sought to determine rates of withdrawal from dialysis and variables associated with withdrawal.
  
  
  METHODS
  Canadian Organ Replacement Registry data were used to examine withdrawal rate and identify variables associated with withdrawal among the total cohort, patients age < 75 years, and patients age ≥ 75 years, along with those with early (eGFR > 10.5 ml/min per 1.73 m(2)) and those with late (eGFR ≤ 10.5 ml/min per 1.73 m(2)) initiation of dialysis, using a Cox proportional hazard model in patients starting dialysis between 2001 and 2009, with follow-up to December 31, 2009.
  
  
  RESULTS
  Median follow-up duration was 23.0 (interquartile range [IQR], 34.3) months. Rate of withdrawal per 100 patient-years doubled from 1.5 to 3.0, and withdrawal as cause of death increased from 7.9% to 19.5% between 2001 and 2009. Early initiation of dialysis was associated with increased withdrawal risk (hazard ratio, 1.17; 95% confidence interval, 1.06-1.30; P=0.002), as were older age, female sex, white race, and late referral to nephrologist. Patients age ≥ 75 years withdrew earlier after dialysis initiation (median, 15.9 [IQR, 27.9] months) compared to those age < 75 years (21.6 [IQR, 35.2] months). Early-start patients withdrew earlier (median, 15.6 [IQR, 28.5] months) compared with late-start patients (20.2 [IQR, 32.9] months).
  
  
  CONCLUSIONS
  In Canada, withdrawal from dialysis has increased significantly over recent years, especially among patients starting with higher eGFRs and in the elderly.
authors.affiliation: Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada.
authors.forename: Amanda D
authors.initials: AD
authors.lastname: Ellwood
authors.forename: S Vanita
authors.initials: SV
authors.lastname: Jassal
authors.forename: Rita S
authors.initials: RS
authors.lastname: Suri
authors.forename: William F
authors.initials: WF
authors.lastname: Clark
authors.forename: Yingo
authors.initials: Y
authors.lastname: Na
authors.forename: Louise M
authors.initials: LM
authors.lastname: Moist
mesh_terms: D000367:Age Factors; D000368:Aged; D002170:Canada; D061345:Early Medical Intervention / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D013997:Time Factors; D028761:Withholding Treatment / Q000706:statistics & numerical data*