Choosing death. Withdrawal from chronic dialysis without medical reason.

We analyzed patients who died on chronic dialysis because they stopped the treatment, although there was no technical dialysis complication or new medical complication. These patients preferred death to the stress of dialysis. This occurred in 26/1766 (1.5%) patients, and was responsible for 26/704 (4%) of all deaths. We compared these 26 patients to 40 competent patients who discontinued treatment when a medical complication arose. The patients were similar in most respects (age, sex, diagnosis, duration of dialysis, living situation, and type of dialysis) and had the same number of medical complications when starting dialysis. However, the patients who stopped dialysis were more often on home dialysis, 8/24 vs. 3/40 of the other patients (p less than 0.05). Overall, stopping was three times more common in home than in center patients (3.0% vs. 1.1%) (p less than 0.02). Relatives responding to a written interview felt that nurses and social workers but not physicians had been helpful in the difficult time surrounding the patient's decision and death. This study indicates that particularly home dialysis patients are at a high risk of discontinuing dialysis because of the stress of the dialysis procedure. A realistic introduction to and realization of their dialysis problems, better training and better psychological support, particularly from physicians, are necessary to eradicate this avoidable cause of death in chronic dialysis patients.