Article Figures & Data
Figures
- Figure 1.
Dialysis withdrawal and hospice status by age, US Renal Data System (USRDS) 2001 to 2002 deceased cohort (N = 115,239).
- Figure 2.
Percentage of patients who withdrew from dialysis and used hospice, by state, USRDS 2001 to 2002 deceased cohort (N = 115,239).
Tables
- Table 1.
Dialysis withdrawal and hospice status of deceased patients, USRDS 2001 to 2002 cohorta
Dialysis Withdrawal and Hospice Status Deceased Patients(N = 115,239) % Mean Age (yr) % Female Race (%)b Mean Months of Dialysis W B Hisp O Hospice, yes 15,565 13.5 73.4 ± 11.0c 51.1c 74.0 16.3 7.7 1.9 32.1 ± 34.7c Hospice, no 99,674 86.5 68.6 ± 13.4 48.1 55.3 30.7 10.0 4.0 37.0 ± 37.7 Withdrawal, yes 25,075 21.8 72.7 ± 11.8d 52.4d 73.1 16.4 7.5 3.0 33.1 ± 34.9d hospice, yes 10,518 41.9 73.9 ± 10.6 51.8 76.8 13.6 7.7 1.8 32.3 ± 34.1 hospice, no 14,557 58.1 71.7 ± 12.3 52.8 70.4 18.5 7.4 3.8 33.7 ± 35.6 Withdrawal, no 81,624 70.8 68.0 ± 13.4 47.4 52.5 32.7 10.7 4.1 37.3 ± 37.7 hospice, yes 2751 3.4 71.7 ± 11.7 47.6 62.7 23.6 10.7 3.0 32.8 ± 34.5 hospice, no 78,873 96.6 67.9 ± 13.5 47.4 52.2 33.0 10.7 4.1 37.5 ± 37.8 Withdrawal status unknown 8540 7.4 71.1 ± 13.2 47.4 64.1 27.0 6.1 2.8 35.6 ± 44.6 ↵a Data are means ± SD. B, black; Hisp, Hispanic; O, other; USRDS, US Renal Data System; W, white.
↵b Race was significantly associated with both withdrawal and hospice status.
↵c Significant at P < 0.001 on bivariate tests of association between variable and hospice, yes, versus hospice, no.
↵d Significant at P < 0.001 on bivariate tests of association between variable and withdrawal, yes, versus withdrawal, no.
- Table 2.
Characteristics associated with hospice use in patients who withdrew from dialysis in the USRDS 2001 to 2002 deceased cohort, n = 25,075a
Characteristic n % Hospice Use (%) Pb Adjusted OR(95% CI) Pc Yes No All 41.9 58.1 Age (yr) <0.001 <0.001 0 to 44 700 2.8 28.1 71.9 Reference 45 to 64 4207 16.8 34.2 65.8 1.29 (1.07 to 1.56) 65 to 74 7447 29.7 41.7 58.3 1.72 (1.43 to 2.07) 75 to 84 9621 38.4 44.8 55.2 1.87 (1.55 to 2.24) ≥85 3100 12.4 47.2 52.8 2.09 (1.71 to 2.54) Gender 0.128 0.935 female 13,137 52.4 41.5 58.5 Reference male 11,938 47.6 42.4 57.6 1.00 (0.95 to 1.06) Race <0.001 <0.001 white 18,326 73.1 44.1 55.9 Reference black 4121 16.4 34.8 65.2 0.72 (0.67 to 0.78) Hispanic 1882 7.5 43.1 56.9 0.80 (0.72 to 0.90) other 746 3.0 25.5 74.5 0.46 (0.38 to 0.55) Time on dialysis (yr) <0.001 0.905 <3 16,052 64.0 42.8 57.2 1.00 (0.94 to 1.06) ≥3 9023 36.0 40.4 59.6 Reference Modalityd 0.711 0.146 hemodialysis 23,705 94.5 41.9 58.1 0.92 (0.81 to 1.03) peritoneal dialysis 1367 5.5 42.4 57.6 Reference Dependence for ADLe <0.001 <0.001 yes 1321 5.3 37.1 62.9 0.78 (0.69 to 0.88) no 23,163 92.4 42.4 57.6 Reference Primary cause of renal failure <0.001 0.007 diabetes 11,047 44.1 41.2 58.8 Reference hypertension 7202 28.7 43.6 56.4 0.95 (0.88 to 1.01) glomerulonephritis 1714 6.8 41.2 58.8 0.93 (0.84 to 1.05) cystic kidney disease 462 1.8 45.7 54.3 1.08 (0.89 to 1.33) urologic 516 2.1 46.1 53.9 1.08 (0.89 to 1.31) other 3021 12.0 41.8 58.2 0.98 (0.90 to 1.07) unknown or missing 1113 4.4 36.6 63.4 0.77 (0.67 to 0.88) Cause of dialysis withdrawal <0.001 <0.001 access failure 471 1.9 42.3 57.7 0.95 (0.78 to 1.17) transplant failure 30 0.1 26.7 73.3 0.54 (0.22 to 1.34) failure to thrive 10,765 42.9 48.5 51.5 1.05 (0.98 to 1.12) medical complication 8845 35.3 30.7 69.3 0.50 (0.46 to 0.54) other 4964 19.8 47.7 52.3 Reference State of residencef 25,075 100.0 — — <0.001 — <0.001 ↵a The χ2 test was used for comparisons between categorical variables. ADL, activities of daily living; CI, confidence interval; OR, odds ratio.
↵b P for bivariate comparisons between those with and without hospice.
↵c On logistic regression.
↵d Data missing for three patients.
↵e Data missing for 591 patients. ADL assessment is completed at dialysis initiation.
↵f State category was significant, but there was wide variation in the χ2 results and OR.
Parameter n Median Cost, Last 6 Mo of Life ($) Median Cost, Last Week of Life ($) Median Hospital Days, Last Week of Life Total cohort 91,687 42,978 (1,392,744) 4827 (255,881) 2.0 (156) Hospice, yes 12,058 42,247 (322,979) 1883 (36,239) 0.0 (16) Hospice, no 79,629 43,090 (1,392,744) 5428 (255,881) 2.0 (156) Withdrawal, yes 19,517 44,222 (776,003) 3502 (106,988) 2.0 (17) hospice, yes 8200 41,853 (322,054)b 1858 (32,992)b 0.0 (16)b hospice, no 11,317 45,950 (776,003) 4878 (106,988) 4.0 (17) Withdrawal, no 65,868 43,029 (1,392,744) 5547 (255,881) 2.0 (156) hospice, yes 2165 45,736 (260,661) 2559 (36,239) 0.0 (8) hospice, no 63,703 42,915 (1,392,744) 5663 (255,881) 2.0 (156) Parameter n Site of Death % Hospice Days (Mean ± SD) Total cohort 91,687 Hospital 63.0 2.0 ± 12.6 Home 16.7 Other 11.9 Unknown 8.4 Hospice, yes 12,058 Hospital 22.9 14.2 ± 30.5 Home 37.6 Hospice, no 79,629 Hospital 69.0 0 Home 13.6 Withdrawal, yes 19,517 Hospital 49.2 4.4 ± 15.5 Home 25.3 Hospice, yes 8200 Hospital 22.5 10.1 ± 21.9 Home 45.3 Hospice, no 11,317 Hospital 68.5 0 Home 10.8 Withdrawal, no 65,868 Hospital 72.9 0.8 ± 9.0 Home 15.8 Hospice, yes 2165 Hospital 41.8 21.0 ± 40.3 Home 37.3 Hospice, no 63,703 Hospital 74.0 0 Home 15.0 - Table 5.
Percentage using hospice by reason for withdrawal and dying in hospital versusat home, USRDS 6-mo cohort
Reason for Withdrawal Death in Hospital Death at Home n Hospice Use (%) n Hospice Use (%) No Yes No Yes Access failure 76 79.0 21.0 104 33.7 66.4 Treatment failure 6 100 0 5 60.0 40.0 Failure to thrive 3260 75.3 24.7 2613 24.4 75.6 Medical complication 4638 85.7 14.3 1113 24.3 75.7 Other 1516 77.5 22.5 1103 24.9 75.1 Total 9596 80.8 19.2 4938 24.8 75.2 - Table 6.
Cause of death, USRDS 2001 to 2002 cohort, by dialysis withdrawal and hospice status
Cause of Death Hospice(%; n = 15,565) Withdrawn(%; n = 25,075) All(%; N = 115,239) Unknown and missing 24.9 9.1 16.4 Cardiac combinationsa 18.2 21.4 22.3 Other identified cause 15.0 16.6 7.6 Cardiac arrest (cause unknown) 14.3 15.3 22.6 Malignancy 9.5 7.2 3.7 Septicemia 5.4 10.6 11.3 Stroke 3.0 5.5 4.2 Dementia 1.3 1.4 0.4 Cachexia 2.5 2.9 1.1 Other with <1%b 6.0 10.1 10.3 ↵a Cardiac combinations included atherosclerotic heart disease, acute myocardial infarction, cardiac arrhythmia, cardiomyopathy, hyperkalemia, and pulmonary edema.
↵b Most common of these diagnoses were pneumonia, ischemic bowel, ischemic brain damage, gastrointestinal hemorrhage, other hemorrhage, other infections, valvular heart disease, and chronic obstructive pulmonary disease.
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