Although both dialysis and renal transplantation are treatment options for patients with CKD, there are patients for whom complications develop, raising the issue of discontinuation of dialysis. In the United States, dialysis withdrawal is the third most common cause of death (15-25%) for patients with CKD.
Patient factors associated with the decision to withdraw from dialysis include:
- Advanced age
- Advanced atherosclerotic disease
- Poorly controlled diabetes mellitus and advanced complications such as
- Loss of vision
- Advanced cardiovascular disease
- Loss of limbs
- Higher physical discomfort index
Interestingly, other factors associated with early withdrawal of dialysis include having a higher educational level—perhaps better preparing a person to weigh the pros and cons of prolonging life that is not of good quality—and gender. More women opt to discontinue dialysis than men.
Usually, there is a precipitating cause for the decision to withdraw from dialysis including:
- Failure to thrive
- Medical complications
- Repeated access failure