Stopping Long-Term Dialysis

Abstract

Dialysis was discontinued in 155 (9 percent) of 1766 patients being treated for end-stage renal disease, accounting for 22 percent of all deaths. Treatment was withdrawn more frequently in older than in younger nondiabetic patients, and more often in young diabetic patients than in young nondiabetic patients. Withdrawal was twice as common in nondiabetic patients with other degenerative disorders (P<0.005); in patients receiving intermittent peritoneal dialysis (P<0.025); and in patients living in nursing homes (P<0.025). Half the patients were competent when the decision to withdraw was made, and 39 percent of this group had no new preceding medical complications. Among incompetent patients, the physician initiated the decision for withdrawal in 73 percent, and the patient's family in 27 percent; all patients had recent medical complications. In the early 1970s the physician initiated the decision in 66 percent of all patients; in the early 1980s this figure had decreased to 30 percent (P<0.0005).