Saeed Fahad, Adil Malik M, Kaleem Umar M, Zafar Taqi T, Khan Abdus Salam, Holley Jean L, Nally Joseph V
Divisions of Nephrology and Hypertension and.
Palliative Care, University of Rochester, Rochester, New York.
Clin J Am Soc Nephrol. 2016 Oct 7;11(10):1744-1751. doi: 10.2215/CJN.07530715. Epub 2016 Jul 21.
Advance care planning, including code/resuscitation status discussion, is an essential part of the medical care of patients with CKD. There is little information on the outcomes of cardiopulmonary resuscitation in these patients. We aimed to measure cardiopulmonary resuscitation outcomes in these patients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Our study is observational in nature. We compared the following cardiopulmonary resuscitation-related outcomes in patients with CKD with those in the general population by using the Nationwide Inpatient Sample (2005-2011): () survival to hospital discharge, () discharge destination, and () length of hospital stay. All of the patients were 18 years old or older.
During the study period, 71,961 patients with CKD underwent in-hospital cardiopulmonary resuscitation compared with 323,620 patients from the general population. Unadjusted in-hospital mortality rates were higher in patients with CKD (75% versus 72%; <0.001) on univariate analysis. After adjusting for age, sex, and potential confounders, patients with CKD had higher odds of mortality (odds ratio, 1.24; 95% confidence interval, 1.11 to 1.34; ≤0.001) and length of stay (odds ratio, 1.11; 95% confidence interval, 1.07 to 1.15; =0.001). Hospitalization charges were also greater in patients with CKD. There was no overall difference in postcardiopulmonary resuscitation nursing home placement between the two groups. In a separate subanalysis of patients ≥75 years old with CKD, higher odds of in-hospital mortality were also seen in the patients with CKD (odds ratio, 1.10; 95% confidence interval, 1.02 to 1.17; =0.01).
In conclusion, we observed slightly higher in-hospital mortality in patients with CKD undergoing in-hospital cardiopulmonary resuscitation.
包括关于是否进行心肺复苏的状态讨论在内的预先医疗计划，是慢性肾脏病患者医疗护理的重要组成部分。关于这些患者心肺复苏的结果，相关信息较少。我们旨在衡量这些患者心肺复苏的结果。
设计、设置、参与者与测量指标：我们的研究本质上是观察性的。我们通过使用全国住院患者样本（2005 - 2011年），比较了慢性肾脏病患者与普通人群在以下与心肺复苏相关的结果：（）存活至出院、（）出院去向以及（）住院时长。所有患者均为18岁及以上。
在研究期间，71961例慢性肾脏病患者接受了院内心肺复苏，而普通人群中有323620例患者接受了院内心肺复苏。单因素分析显示，慢性肾脏病患者的未调整院内死亡率更高（75%对72%；P<0.001）。在对年龄、性别和潜在混杂因素进行调整后，慢性肾脏病患者的死亡几率更高（优势比，1.24；95%置信区间，1.11至1.34；P≤0.001），住院时长也更长（优势比，1.11；95%置信区间，1.07至1.15；P = 0.001）。慢性肾脏病患者的住院费用也更高。两组之间心肺复苏后入住疗养院的情况总体上没有差异。在对年龄≥75岁的慢性肾脏病患者进行的单独亚组分析中，慢性肾脏病患者的院内死亡几率也更高（优势比，1.10；95%置信区间，1.02至1.17；P = 0.01）。
总之，我们观察到接受院内心肺复苏的慢性肾脏病患者的院内死亡率略高。
