Trends in in-hospital cardiopulmonary resuscitation and survival in adults receiving maintenance dialysis.
OBJECTIVE
Understanding cardiopulmonary resuscitation (CPR) practices and outcomes can help to support advance care planning in patients receiving maintenance dialysis.


OBJECTIVE
To characterize patterns and outcomes of in-hospital CPR in US adults receiving maintenance dialysis.


METHODS
This national retrospective cohort study studied 663,734 Medicare beneficiaries 18 years or older from a comprehensive national registry for end-stage renal disease who initiated maintenance dialysis from January 1, 2000, through December 31, 2010.


METHODS
Receipt of in-hospital CPR from 91 days after dialysis initiation through the time of death, first kidney transplantation, or end of follow-up on December 31, 2011.


METHODS
Incidence of CPR and survival after the first episode of CPR recorded in Medicare claims during follow-up.


RESULTS
The annual incidence of CPR for the overall cohort was 1.4 events per 1000 in-hospital days (95% CI, 1.3-1.4). A total of 21.9% CPR recipients (95% CI, 21.4%-22.3%) survived to hospital discharge, with a median postdischarge survival of 5.0 months (interquartile range, 0.7-16.8 months). Among patients who died in the hospital, 14.9% (95% CI, 14.8%-15.1%) received CPR during their terminal admission. From 2000 to 2011, there was an increase in the incidence of CPR (1.0 events per 1000 in-hospital days; 95% CI, 0.9-1.1; to 1.6 events per 1000 in-hospital days; 95% CI, 1.6-1.7; P for trend <.001), the proportion of CPR recipients who survived to discharge (15.2%; 95% CI, 11.1%-20.5%; to 28%; 95% CI, 26.7%-29.4%; P for trend <.001), and the proportion of in-hospital deaths preceded by CPR (9.5%; 95% CI, 8.4%-10.8%; to 19.8%; 95% CI, 19.2%-20.4%; P for trend <.001), with no substantial change in duration of postdischarge survival.


CONCLUSIONS
Among a national cohort of patients receiving maintenance dialysis, the incidence of CPR was higher and long-term survival worse than reported for other populations.
Kidney Research Institute, University of Washington, Seattle2Cambia Palliative Care Center of Excellence, University of Washington, Seattle3Department of Medicine, University of Washington, Seattle.
Susan P Y
SP
Wong
Center for Cost and Outcomes Research, University of Washington, Seattle.
William
W
Kreuter
Cambia Palliative Care Center of Excellence, University of Washington, Seattle3Department of Medicine, University of Washington, Seattle.
J Randall
JR
Curtis
Kidney Research Institute, University of Washington, Seattle2Cambia Palliative Care Center of Excellence, University of Washington, Seattle3Department of Medicine, University of Washington, Seattle5Veterans Affairs Puget Sound Healthcare System, Seattle.
Yoshio N
YN
Hall
Kidney Research Institute, University of Washington, Seattle2Cambia Palliative Care Center of Excellence, University of Washington, Seattle3Department of Medicine, University of Washington, Seattle5Veterans Affairs Puget Sound Healthcare System, Seattle.
Ann M
AM
O'Hare
D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000401:mortality / Q000639:trends*; D005260:Female; D006323:Heart Arrest / Q000150:complications* / Q000628:therapy; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012042:Registries; D006435:Renal Dialysis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology