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Trends in in-hospital cardiopulmonary resuscitation and survival in adults receiving maintenance dialysis.

Wong SP, Kreuter W, Curtis JR, Hall YN, O'Hare AM. Trends in in-hospital cardiopulmonary resuscitation and survival in adults receiving maintenance dialysis. JAMA internal medicine. 2015 Jun 1; 175(6):1028-35.

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Abstract:

IMPORTANCE: 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. DESIGN, SETTING, AND PARTICIPANTS: 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. EXPOSURES: 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. MAIN OUTCOMES AND MEASURES: 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 AND RELEVANCE: 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.





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