Outcomes of In-Hospital Cardiopulmonary Resuscitation in Maintenance Dialysis Patients

Abstract

Outcomes of cardiopulmonary resuscitation (CPR) in hospitalized patients with ESRD requiring maintenance dialysis are unknown. Outcomes of in-hospital CPR in these patients were compared with outcomes in the general population using data from the Nationwide Inpatient Sample (NIS;2005. The study population included all adults ($18years old) from the general population and those with a history of ESRD. Baseline characteristics, in-hospital complications, and discharge outcomes were compared between the two groups. The effects of in-hospital CPR on mortality, length of stay, hospitalization charges, and discharge destination were analyzed. Yearly national trends in survival, discharge to home, and length of stay were also examined using the Cochran-Armitage trend test. During the study period, 56,069 patients with ESRD underwent in-hospital CPR compared with 323,620 patients from the general population. Unadjusted in-hospital mortality rates were higher in patients with ESRD (73.9% versus 71.8%, P,0.001) on univariate analysis. After adjusting for age, gender, and potential confounders, patients with ESRD had higher odds of mortality (odds ratio, 1.24; 95% confidence interval, 1.11 to 1.3; P,0.001). Survival after CPR improved in the year 2011 compared with 2005 (31% versus 21%, P,0.001). Multivariate analysis also revealed that a greater proportion of patients with ESRD who survived were discharged to skilled nursing facilities. In conclusion, outcomes after in-hospital CPR are improving in patients with ESRD but remain worse than outcomes in the general population. Patients with ESRD who survive are more likely to be discharged to nursing homes. 26: 3093-3101, 201526: 3093-3101, . doi: 10.1681 Ventricular arrhythmias and sudden and cardiac death necessitating cardiopulmonary resuscitation (CPR) are common occurrences in patients on maintenance dialysis. 1,2 Such events mostly occur during dialysis and only 56% of these patients present to the hospital alive, with 24% of those surviving to the hospital discharge and 15% alive at least 1year after the event. 1 However, few data are available on the outcomes of CPR in hospitalized patients with ESRD. The existing literature consists of small and older studies that do not reflect current standards of CPR practices. In a study of 74 patients with ESRD undergoing CPR in both hospital and dialysis units, 37% survived the initial resuscitation; 6% were alive at the time of hospital discharge, and 3% were still living 6 months later. 3 Patients without ESRD had similar immediate (27%) survival and survival to hospital discharge was not significantly better (6% in patients on dialysis and 30% in patients without ESRD). However, post-CPR survival at 6 months was significantly better in patients without ESRD (2% in patients on dialysis versus 23% in patients without ESRD, J Am Soc Nephrol

Trends in Receipt of Intensive Procedures at the End of Life Among Patients Treated With Maintenance Dialysis

“…Nevertheless, it is not possible to tell from our results whether an upward trend in use of intensive procedures among decedents with ESRD has occurred as part of a broader trend toward more widespread use of these procedures more generally in this population. 13, 14 Finally, our study findings may not necessarily apply to racial/ethnic groups that were excluded from this study, such as American Indians, Alaska Natives, Asians, Native Hawaiians, Pacific Islanders or those of other race.…”

Outcomes of In–Hospital Cardiopulmonary Resuscitation in Patients with CKD

“…Patients with cardiopulmonary arrest (427.50) as a primary diagnosis were excluded to avoid including those Table 1. Demographics, clinical, and hospital characteristics in patients with and without CKD undergoing cardiopulmonary resuscitation from the Nationwide Inpatient Sample from 2005 to 2011 who had experienced an out of hospital event in our analyses (8).…”

Serious Illness Conversations in ESRD

“…Mortality in the first year on dialysis for patients over 75 years old approaches 40% (2), and even those with better prognoses face multiple hospitalizations and declining functional status (3)(4)(5). Long-term outcomes from aggressive treatment, such as cardiopulmonary resuscitation, are poor in patients on dialysis (6), and recent data also suggest that, for individuals over age 80 years old, dialysis may offer little to no benefit over conservative management (7,8). In the last month of life, patients on dialysis over age 65 years old experience higher rates of hospitalization, intensive care unit admission, procedures, and death in hospital than patients with cancer or heart failure, while using hospice services less (9).…”