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Dialysis Patients' Preferences on Resuscitation: A Cross-Sectional Study Design
Husam Alzayer1,2, Annette M Geraghty3, Kuruvilla K Sebastian4,5,6
1Department of Nephrology, University Hospital Galway, Ireland.
Canadian Journal of Kidney Health and Disease
|August 4, 2022
Summary
Patients with end-stage kidney disease undergoing dialysis show a strong preference for cardiopulmonary resuscitation (CPR) and mechanical ventilation. However, most have not discussed advance care planning (ACP), indicating a need for better communication.
Area of Science:
- Nephrology
- Geriatrics
- Palliative Care
Background:
- End-stage kidney disease (ESKD) significantly elevates cardiovascular mortality risk.
- Cardiopulmonary resuscitation (CPR) in ESKD patients yields poor outcomes and increases morbidity.
Purpose of the Study:
- To evaluate patient preferences for CPR and advance care planning (ACP) among individuals with ESKD.
- To understand how treatment burden and anticipated outcomes influence patient decisions.
Main Methods:
- A cross-sectional study was conducted in two outpatient dialysis units.
- Seventy adult dialysis patients completed structured interviews using the Willingness to Accept Life-Sustaining Treatment (WALT) tool.
- Data included demographics, cognitive assessments, health status, and comorbidity indices.
Main Results:
- Over 75% of participants favored CPR and mechanical ventilation in their current health state.
- Willingness to accept treatment decreased significantly with anticipated severe functional or cognitive impairment.
- More than 94% of patients had not discussed ACP, with 59.4% desiring to do so with their nephrologist.
Conclusions:
- Patient preferences for life-sustaining treatments are closely linked to perceived treatment burden and expected outcomes.
- There is a critical need to integrate ACP discussions into routine chronic kidney disease (CKD) management.
- Improved communication regarding ACP can enhance patient involvement in their care decisions.
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