Withdrawal from dialysis in Switzerland between 2014 and 2021

ABSTRACT

Background: A recent Dutch study suggests that dialysis withdrawal has increased over the last years. The aims of this study were to investigate whether this is also the case in Switzerland, and to identify factors associated with withdrawal. Methods or Case description In this retrospective study, data were retrieved from the Swiss Dialysis Registry (srrqap). Annual death rates and causes of death were analyzed between 2014-2021. We compared clinical characteristics of patients who were withdrawn for medical/other reasons or who withdrew from dialysis with those who had another cause of death and with those who stayed alive. Results or Learning points A total of 7'246 incident patients on hemodialysis or peritoneal dialysis between 2014-2021 were included;of those, 2'325 patients died. In 2020, there was an above-average number of deaths, due to the coronavirus pandemic. Dialysis withdrawal because the patient refused further treatment represented 8.3-13.3% of all causes of death. Withdrawal by the patient did not increase throughout the study period, but withdrawal for medical/other reasons increased from 6.2 to 8.9% (see figure). Patients who died because of withdrawal from dialysis were significantly older and longer on dialysis than those with other causes of death, and had suffered less often from COVID-19. In multivariate regression analysis adjusted for age, sex, and Charlson score, testing negative for coronavirus was the only factor associated with withdrawal by the patient, whereas withdrawal for medical or other reason was also associated with higher age. Conclusion(s) Unlike the Netherlands, dialysis withdrawal is not the leading cause of death in Switzerland, and withdrawal by the patient has not increased, not even during the COVID-19 epidemic. However, the percentage of patients who was withdrawn for medical/other reasons increased during this period, for unclear reasons. The only risk factors for withdrawal were higher age and - surprisingly - testing negative for the coronavirus.