Factors Associated with Dialysis Discontinuation Outside of the Acute Care Setting

Elective discontinuation of dialysis is an increasingly common occurrence among patients with ESKD (1,2). Numerous studies have assessed predictors of the decision to stop dialysis in the inpatient setting and have consistently highlighted factors associated with a higher likelihood of this decision, including White race, female sex, and older age (3,4). In these settings, the decision to stop dialysis is often made in the context of acute medical complications or hospitalizations. Although these findings are important, there has been less focus on understanding the decision to discontinue dialysis outside of the acute hospitalized setting. In such cases, patients and their loved ones would benefit from shared decision making, which is recommended to help patients understand their prognosis and make complex treatment decisions (5). Reasons for discontinuing dialysis after acute medical illness in the inpatient setting likely differ from those outside such scenarios; understanding the factors associated with this decision in the outpatient setting could help guide the counseling of these patients, particularly as recommendations for the use of time-limited trials of dialysis in patients with multiple comorbidities increase (6,7). The objective of this study was to determine factors associated with dialysis discontinuation in the absence of known acute medical complications, with particular focus on differences in discontinuation according to treatment modality ( e.g ., peritoneal dialysis [PD] versus hemodialysis [HD]). Additionally, we assessed whether factors that were associated with the decision to stop dialysis differed between patients who chose to discontinue dialysis earlier (within 2 years of dialysis initiation) versus later in the course of chronic maintenance dialysis. We performed a retrospective observational study using data from the United States Renal Data System (USRDS) and included adults (age ≥18 years) who started dialysis between January 1, 2005 and December 31, 2015. We excluded …