High CPR Rates, Poor Survival in Dialysis Patients

Hemodialysis patients have a high rate of in-hospital cardiopulmonary resuscitation (CPR), with low rates of long-term survival after CPR, according to a study in JAMA Internal Medicine.

Rates and outcomes of in-hospital CPR were assessed in 663,734 Medicare beneficiaries who started maintenance dialysis from 2000 through 2010, identified from the US Renal Data System registry. All hospital admissions and in-hospital CPR events occurring more than 90 days after dialysis initiation were assessed, along with survival to hospital discharge after the first CPR event.

In this national cohort, the annual incidence of CPR was 1.4 events per 1000 hospital days. Survival to discharge after CPR was 21.9 percent; median survival after discharge was 5.0 months. About 15 percent of patients who died in the hospital underwent CPR during that admission.

The incidence of in-hospital CPR events per 1000 in-hospital days increased from 1.0 in 2000 to 1.6 in 2011, while the percentage of patients surviving to discharge increased from 15.2 percent to 28.0 percent. The percentage of in-hospital deaths with CPR during the terminal hospitalization increased from 9.5 percent to 19.8 percent. There was no change in postdischarge survival after CPR.

These national data suggest a rising incidence of in-hospital CPR among hemodialysis patients, despite poor survival after CPR. The researchers conclude, “These findings support the relevance of advance care planning and setting realistic expectations regarding resuscitation treatment in this population [Wong SPY, et al: Trends in in-hospital cardiopulmonary resuscitation and survival in adults receiving maintenance dialysis. JAMA Intern Med 2015; doi: 10.1001/jamainternmed.2015.0406].