Article

Review of In-Hospital Cardiac Arrest Outcomes for Dialysis-Dependent Patients with End-Stage Kidney

Surprising results show few differences compared to non-dialysis-dependent patients

Emergency response in hospital

New research analyzing outcomes among dialysis-dependent patients with end-stage kidney disease (ESKD) following in-hospital cardiac arrest dispels a common concern that those patients experience poorer outcomes.

Duke nephrologist Patrick H. Pun, MD, MHS, an author of the study published in January in the Clinical Journal of the American Society of Nephrology, says the research demonstrated that survival to discharge was comparable for dialysis-dependent patients to those who are not.

The study examined a nation-wide registry, the American Heart Association’s Get with The Guidelines®-Resuscitation (GWTG-R), where participating hospitals collected data on all in-hospital cardiac arrest resuscitation events to measure outcomes. Resuscitation procedures following any cardiac arrest in these hospitals is carefully documented, permitting a comprehensive review, says Pun, a researcher and specialist in treating patients requiring dialysis.

The authors examined resuscitation records from more than 31,100 patients in GWTG-R, which was linked to Centers for Medicare and Medicaid Services data to identify more than 8,400 patients with ESKD receiving maintenance dialysis from 2000 to 2012.

Pun says the analysis attempted to answer several questions:

  • How did the resuscitation process take place?
  • Were dialysis patients treated differently during resuscitation than non-dialysis patients?
  • Did the resuscitation effort reflect a different level of intensity? If so, did that affect outcomes?

“Our a priori hypotheses on this comparison was that the patients on maintenance dialysis would experience lower-quality resuscitation care and lower survival rates, based on previous studies,” Pun says.

Minor differences in resuscitation quality

The study identified minor differences in resuscitation quality between patient groups, Pun notes. “But, as a whole, we found no major differences in the intensity of the effort. It’s reassuring to learn that, for the most part, patients on maintenance dialysis are not being treated differently in terms of resuscitation efforts.”

Pun says the overall results were surprising. “The patients dependent on dialysis had pretty much the same outcomes as patients who were not dependent. Survival to hospital discharge is just about the same, and the patients on dialysis were slightly more likely to leave the hospital with lower burden of neurologic disability.”

However, long-term outcomes following hospital discharge were not available for this study, and previous analyses have suggested that dialysis patients have shorter post-arrest lifespans. “The appropriate way to advise dialysis patients about the overall success rate of CPR after cardiac arrest is the subject of a great amount of debate, and our study on in-hospital outcomes adds another layer of nuance to the discussion” he says.

Previous analyses of post-arrest outcomes relied on administrative records that lacked detailed data on the cause and circumstances of the cardiac arrest. Significantly, none of the previous research had reviewed the intensity of the CPR performed.