Dialysis Patients' Preferences on Resuscitation: A Cross-Sectional Study Design.

BACKGROUND

End-stage kidney disease is associated with a 10- to 100-fold increase in cardiovascular mortality compared with age-, sex-, and race-matched population. Cardiopulmonary resuscitation (CPR) in this cohort has poor outcomes and leads to increased functional morbidity.

OBJECTIVE

The aim of this study is to assess patients' preferences toward CPR and advance care planning (ACP).

DESIGN

cross-sectional study design.

SETTING

Two outpatient dialysis units.

PATIENTS

Adults undergoing dialysis for more than 3 months were included. Exclusion criteria were severe cognitive impairment or non-English-speaking patients.

MEASUREMENTS

A structured interview with the use of Willingness to Accept Life-Sustaining Treatment (WALT) tool.

METHODS

Demographic data were collected, and baseline Montreal Cognitive Assessment, Patient Health Questionnaire-9, Duke Activity Status Index, Charlson comorbidity index, and WALT instruments were used. Descriptive analysis, chi-square, and test were performed along with probability plot for testing hypotheses.

RESULTS

Seventy participants were included in this analysis representing a 62.5% response rate. There was a clear association between treatment burden, anticipated clinical outcome, and the likelihood of that outcome with patient preferences. Low-burden treatment with expected return to baseline was associated with 98.5% willingness to accept treatment, whereas high-burden treatment with expected return to baseline was associated with 94.2% willingness. When the outcome was severe functional or cognitive impairment, then 45.7% and 28.5% would accept low-burden treatment, respectively. The response changed based on the likelihood of the outcome. In terms of resuscitation, more than 75% of the participants would be in favor of receiving CPR and mechanical ventilation at their current health state. Over 94% of patients stated they had never discussed ACP, whereas 59.4% expressed their wish to discuss this with their primary nephrologist.

LIMITATIONS

Limited generalizability due to lack of diversity. Unclear decision stability due to changes in health status and patients' priorities.

CONCLUSIONS

ACP should be incorporated in managing chronic kidney disease (CKD) to improve communication and encourage patient involvement.