{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:45:32Z","timestamp":1786373132053,"version":"build-2736575974"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,2]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>The number of elderly patients and those with higher estimated GFR (eGFR) initiating dialysis have recently increased. This study sought to determine rates of withdrawal from dialysis and variables associated with withdrawal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, &amp; measurements<\/jats:title>\n                    <jats:p>\n                      Canadian Organ Replacement Registry data were used to examine withdrawal rate and identify variables associated with withdrawal among the total cohort, patients age &lt; 75 years, and patients age \u2265 75 years, along with those with early (eGFR &gt; 10.5 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      ) and those with late (eGFR \u2264 10.5 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      ) initiation of dialysis, using a Cox proportional hazard model in patients starting dialysis between 2001 and 2009, with follow-up to December 31, 2009.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median follow-up duration was 23.0 (interquartile range [IQR], 34.3) months. Rate of withdrawal per 100 patient-years doubled from 1.5 to 3.0, and withdrawal as cause of death increased from 7.9% to 19.5% between 2001 and 2009. Early initiation of dialysis was associated with increased withdrawal risk (hazard ratio, 1.17; 95% confidence interval, 1.06\u20131.30;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.002), as were older age, female sex, white race, and late referral to nephrologist. Patients age \u2265 75 years withdrew earlier after dialysis initiation (median, 15.9 [IQR, 27.9] months) compared to those age &lt; 75 years (21.6 [IQR, 35.2] months). Early-start patients withdrew earlier (median, 15.6 [IQR, 28.5] months) compared with late-start patients (20.2 [IQR, 32.9] months).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In Canada, withdrawal from dialysis has increased significantly over recent years, especially among patients starting with higher eGFRs and in the elderly.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.01000112","type":"journal-article","created":{"date-parts":[[2012,10,19]],"date-time":"2012-10-19T20:51:13Z","timestamp":1350679873000},"page":"265-270","source":"Crossref","is-referenced-by-count":49,"title":["Early Dialysis Initiation and Rates and Timing of Withdrawal From Dialysis in Canada"],"prefix":"10.2215","volume":"8","author":[{"given":"Amanda D.","family":"Ellwood","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Vanita","family":"Jassal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita S.","family":"Suri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William F.","family":"Clark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingo","family":"Na","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise M.","family":"Moist","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-15-20230811","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.1001\/jama.1996.03540200038028","article-title":"Advance directives and withdrawal of dialysis in the United States, Germany, and Japan.","volume":"276","author":"Sehgal","year":"1996","journal-title":"JAMA"},{"key":"R2-15-20230811","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1681\/ASN.V391631","article-title":"Death by withdrawal from dialysis: A 20-year clinical experience.","volume":"3","author":"Mailloux","year":"1993","journal-title":"J Am Soc Nephrol"},{"key":"R3-15-20230811","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1681\/ASN.2004070550","article-title":"Suicide in the United States end-stage renal disease program.","volume":"16","author":"Kurella","year":"2005","journal-title":"J Am Soc Nephrol"},{"key":"R4-15-20230811","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1111\/j.1523-1755.2005.00525.x","article-title":"Factors associated with \u201cdo not resuscitate\u201d orders and rates of withdrawal from hemodialysis in the international DOPPS.","volume":"68","author":"Fissell","year":"2005","journal-title":"Kidney Int"},{"key":"R5-15-20230811","doi-asserted-by":"crossref","first-page":"1755","DOI":"10.1681\/ASN.V8111755","article-title":"An analysis of risk factors for withdrawal from dialysis before death.","volume":"8","author":"Leggat","year":"1997","journal-title":"J Am Soc Nephrol"},{"key":"R6-15-20230811","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1056\/NEJM198601023140103","article-title":"Stopping long-term dialysis. 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