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

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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 t 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.