Assuntos
Hispânico ou Latino/genética , Judeus/genética , Pênfigo/epidemiologia , Pênfigo/genética , População Branca/genética , Antígenos HLA-DQ/genética , Antígenos HLA-DQ/isolamento & purificação , Cadeias beta de HLA-DQ , Antígenos HLA-DR/genética , Antígenos HLA-DR/isolamento & purificação , Cadeias HLA-DRB1 , Humanos , New Mexico/epidemiologia , Reação em Cadeia da Polimerase , PrevalênciaRESUMO
To characterize the factors affecting the decision to withdraw from dialysis, the authors compared patients withdrawing from dialysis (n=62) with patients dying from all other causes (n=242) over 21 years (1976-1996) in a single dialysis unit. Compared with those who died from other causes, patients who withdrew were older (67+/-11 vs 61+/-11 years); were more likely to have severe physical impairment (87% vs 62%) and severe restriction of activities of daily living (77% vs 46%); and had higher frequencies of congestive heart failure (81 % vs 62%), myocardial infarction (60% vs 42%), peripheral vascular disease (71 % vs 40%), and diabetes mellitus (66% vs 36%) (p < or = 0.014). Dialysis modality; duration of dialysis; the degree of family support; index of disease severity; the use of tobacco, alcohol, or illicit drugs; and the frequency of ischemic heart disease, dysrhythmia, pericarditis, cardiac arrest, cerebrovascular accident, hypertension, obstructive lung disease, cancer, and human immunodeficiency virus did not differ between the two groups. Stepwise logistic regression showed that dialysis during 1990-1996, severe limitation of activities of daily living, and diabetes mellitus were independent risk factors for withdrawal. During 1990-1996, 44% of the deaths were caused by withdrawal from treatment. In addition to other factors, dialysis in the 1990s is a strong predictor of withdrawal from dialysis. The reasons for the increased rate of withdrawal from dialysis in recent years, and the effect of this increased rate of withdrawal on mortality, need further evaluation.
Assuntos
Diálise Renal/mortalidade , Recusa do Paciente ao Tratamento , Suspensão de Tratamento , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/mortalidade , Comorbidade , Diabetes Mellitus/mortalidade , Insuficiência Cardíaca/mortalidade , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , New Mexico , Qualidade de Vida , Diálise Renal/tendências , Fatores de Risco , Mudança SocialRESUMO
Since 1991, death following withdrawal from dialysis has increased greatly in our dialysis unit. This report is based on our observations of those patients who followed that course. Four types of patients who withdrew from dialysis were identified: those with a terminal illness, demented patients, those with a progressive disability, and those who had no serious medical problem other than end-stage renal failure. We analyzed the risk factors for withdrawal and attempted to define the ethical principles involved in each patient category. The authors conclude that although the decision of a competent patient to stop dialysis must be honored, some of those deaths might be preventable if patients on chronic dialysis are prospectively followed and treated by those who are expert in the behavior of patients with chronic illness.
