How do outcomes for in-hospital cardiac arrest differ in patients treated with dialysis?

January 07, 2020

HighlightsWashington, DC (January 7, 2020) -- A new study indicates that there are opportunities to improve the quality of care for patients on dialysis who experience cardiac arrest while in the hospital, but survival rates are similar for these patients compared with patients not on dialysis. The findings appear in an upcoming issue of CJASN.

Sudden cardiac arrest is the leading cause of death for patients on dialysis, and previous studies have suggested that for patients who experience cardiac arrest while in the hospital, those who are on dialysis tend to fare worse than those who are not on dialysis. Using a more comprehensive clinical registry of patients with in-hospital cardiac arrest, a team led by Patrick H. Pun, MD, MHS and Monique Anderson Starks, MD, MHS (Duke Clinical Research Institute) re-examined survival outcomes in dialysis patients, and also assessed whether the intensity and quality of cardiopulmonary resuscitation had any relationship to why dialysis patients tend to have worse outcomes. The analysis included information on 31,144 patients (27% on dialysis) who experienced cardiac arrest in 372 hospitals across the United States.

Among the major findings: "While we found that there were some resuscitation parameters that were lower quality for dialysis patients compared to non-dialysis patients, after accounting for differences in clinical comorbidities, demographics and cardiac arrest characteristics, we found that dialysis patients had similar to better survival outcomes compared with non-dialysis patients," said Dr. Pun. "In light of previous data, while overall cardiac arrest survival rates are still low at 23%, this suggests that cardiopulmonary resuscitation is not necessarily futile for dialysis patients, and it may be as effective in improving in-hospital survival for dialysis patients as it is for other patients."

An accompanying editorial stresses the importance of having conversations with patients about their wishes regarding resuscitation.
-end-
Study co-authors include Jingjing Wu, MS, Eric D. Peterson, MD, MPH, Judith A. Stafford, MS, Roland A. Matsouaka, L. Ebony Boulware, MD, MPH, Laura P. Svetkey, and Paul S Chan, MD, MSc.

Disclosures: Eric Peterson reports research grants from Amgen, Abiomed, AstraZeneca, Novartis, Bayer AG, Genentech, Janssen Pharmaceutica Products, LP, Merck and Co, Regeneron Pharmaceuticals, Inc, Sonofi-Aventis, and the Society of Thoracic Surgeons. Paul Chan reports research funding from the National Heart, Lung, and Blood Institute, and he is a consultant for the American Heart Association. The other authors report no conflict of interest disclosures.

The article, entitled "In-Hospital Cardiac Arrest Resuscitation Practices and Outcomes in Maintenance Dialysis Patients," will appear online at http://cjasn.asnjournals.org/ on January 7, 2020, doi: 10.2215/CJN.05070419.

The editorial, entitled "Reconciling Short and Long-Term Outcomes of In-Hospital Cardiac Arrest in Patients Undergoing Maintenance Dialysis," will appear online at http://cjasn.asnjournals.org/ on January 7, 2020, doi: 10.2215/CJN.14121119.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Since 1966, the American Society of Nephrology (ASN) has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has more than 21,000 members representing 131 countries. For more information, visit http://www.asn-online.org.

American Society of Nephrology

Related Dialysis Articles from Brightsurf:

Immediate dialysis no better than wait-until-necessary approach, researchers find
In the largest international study of its kind, researchers at the University of Alberta and Toronto's St.

Predictors of 5-year mortality in young dialysis patients
The analysis published in NDT [1] evaluated for the first time the association of a large number of demographic, HD treatment and laboratory variables with mortality in patients on chronic hemodialysis treatment since childhood.

COVID-19 mortality alarmingly high in dialysis patients
Analysis of a Spanish experience shows that COVID-19 is frequent in hemodialysis patients, who appear to be at risk for worse outcome.

Survival following switch from urgent in-center hemodialysis to home dialysis
Few patients who start urgent and unplanned dialysis in clinical centers switch to home dialysis.

Is ownership of dialysis facilities associated with access to kidney transplants?
An analysis that included data for nearly 1.5 million patients with end-stage kidney disease looked at whether ownership of dialysis facilities was associated with patients' access to kidney transplants.

At-home dialysis improves quality of life
The rate of people starting voluntary at-home peritoneal dialysis rose from 15% to 34% over 10 years at Kaiser Permanente in Northern California, providing a convenient and safe way to manage advanced-stage kidney disease compared with center-based hemodialysis, according to research published today in JAMA Internal Medicine.

Hydration sensor could improve dialysis
Researchers from MIT and Massachusetts General Hospital have now developed a portable sensor that can accurately measure patients' hydration levels using a technique known as nuclear magnetic resonance (NMR) relaxometry.

Uncovering possible role of polyphosphate in dialysis-related amyloidosis
Researchers from Osaka University found that the low concentrations of the naturally occurring biopolymer, polyphosphate (polyP), induces amyloid formation from β2 microglobulin under both acidic and neutral conditions but by different mechanisms.

Study compares dialysis reimbursement around the globe
Dialysis reimbursement policies in most countries are focused on conventional in-center hemodialysis, although home hemodialysis and peritoneal dialysis might contribute to quality of life and cost savings.

Elderly patients on dialysis have a high risk of dementia
Older kidney disease patients who are sick enough to require the blood-filtering treatment known as dialysis are at high risk of dementia, including Alzheimer's disease, according to a study led by scientists at Johns Hopkins Bloomberg School of Public Health.

Read More: Dialysis News and Dialysis Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.