Dr Kate Brotherton1, Bobby Chacko1,2, Namrata Khanal3, Kamal Sud4,5, Ginger Chu2, Scott Jones1, Tim Spicer6, Chandana Guha5, Shyam Muthuramalingam7, Jasmin Mazis8, Stephen McDonald8,9,10, Pedro Franca Gois1,11
1Nephrology and Transplantation, John Hunter Hospital, Newcastle, Australia, 2The University of Newcastle, Newcastle, Australia, 3St Vincent’s Hospital, Sydney, Australia, 4Nepean Hospital, Kingswood, Australia, 5The University of Sydney, Sydney, Australia, 6South West Sydney Local Health District, Sydney, Australia, 7South Australia Health, Marden, Australia, 8Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia, 9Royal Adelaide Hospital, Adelaide, Australia, 10The University of Adelaide, Adelaide, Australia, 11The University of Queensland, Brisbane, Australia
Biography:
Dr Kate Brotherton is a nephrology advanced trainee with an interest in dialysis and public health, in particular sociocultural and economic disparities. She has attained a diploma in Public Health and Tropical Medicine (James Cook University) and has worked across regional and remote Australia including New South Wales, Victoria, South Australia and the Northern Territory.
Aim:
To examine patterns of dialysis withdrawal among culturally and linguistically diverse (CALD) patients in Australia.
Background:
The CALD-KF Study previously identified disparities in kidney replacement therapy (KRT) outcomes among CALD populations. Whether similar disparities exist in dialysis withdrawal remains unclear.
Methods:
We analysed non-Indigenous adults who commenced haemodialysis (HD) or peritoneal dialysis in Australia from 2002–2023 using the ANZDATA registry. Patients were grouped by place of birth: Australia/New Zealand (Aus/NZ), other English-speaking countries (CALD-English), and non-English-speaking countries (CALD-non-English). We used chi-squared tests and multinomial logistic regression to assess associations between CALD-groups and dialysis withdrawal.
Results:
Among 50,232 patients, 8,989 patients withdrew from dialysis (62% male; mean age 71±11 years; dialysis vintage 3.9±3.3 years; 78% on facility HD). Of those who withdrew, 69% were Aus/NZ-born, 8.4% CALD-English and 22.7% CALD-non-English. Compared to those who did not withdraw, patients who withdrew were older (71 vs. 61 years), and had higher cardiovascular (42.5% vs. 30.5%), cerebrovascular (16.5% vs. 9.3%), peripheral vascular (23.4% vs. 15.7%) and respiratory (15.8% vs. 11.4%) comorbidities (p<0.001). CALD-non-English had the lowest proportion of withdrawal deaths (24.9%), compared to Aus/NZ (33.5%) and CALD-English (35.7%) (p<0.001). After adjusting for demographic, clinical, and socioeconomic factors, CALD-non-English patients were less likely to withdraw (RRR 0.54, 95%CI 0.51–0.57; p < 0.001) compared to Aus/NZ, with consistent results across withdrawal causes.
Conclusion:
CALD-non-English patients were significantly less likely to withdraw from dialysis, independent of key confounders. This disparity may reflect cultural values, health literacy, communication barriers, and end-of-life perceptions. Enhancing culturally sensitive shared decision-making, including interpreter access and tailored palliative care, is essential. Further research should examine the roles of family, religion, and clinician–patient communication in withdrawal decisions.
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