Abstract
Background: Patients with advanced kidney disease have a symptomatic and psychological burden which warrant renal supportive care or palliative care. However, the impact of do-not-resuscitate consent type (signed by patients or surrogates) on end-of-life treatments in these patients remains unclear. Objective: We aim to identify influential factors correlated with different do-not-resuscitate consent types in patients with advanced kidney disease and the impact of do-not-resuscitate consent types on various life-prolonging treatments. Methods: This was a retrospective observational study. We included patients aged 20 years and over, diagnosed with advanced kidney disease and receiving palliative and hospice care consultation services between January 2014 and December 2018 in a tertiary teaching hospital in Taiwan. We reviewed medical records and used logistic regression to identify factors associated with do-not-resuscitate consent types and end-of-life treatments. Results: A total of 275 patients were included, in which 21% signed their do-not-resuscitate consents. A total of 233 patients were followed until death, and 32% of the decedents continued hemodialysis, 75% underwent nasogastric (NG) tube placement, and 70% took antibiotics in their final seven days of life. Do-not-resuscitate consents signed by patients were associated with reduced life-prolonging treatments including feeding tube placement and antibiotic use in the last seven days (odd ratio and 95% confidence interval were 0.16, 0.07–0.34 and 0.33, 0.16–0.69, respectively) compared to do-not-resuscitate consents signed by surrogates. Conclusions: Do-not-resuscitate consent signed by patients and not by surrogates may reflect better patients’ autonomy and reduced life-prolonging treatments in the final seven days of patients with advanced kidney disease.
Highlights
Global prevalence of chronic kidney disease (CKD) prevalence varies from 23–36%in people aged >64 years worldwide [1]
Performance status score 1–4 represents the following: 1—Symptomatic but completely ambulatory; 2—Symptomatic, 50% in bed, but not bedbound; 4—Bedbound. This is the first investigation on how DNR consent signed by patients themselves could be vital in various end-of-life treatments in terminally ill patients with advanced kidney disease in the Asian context
The DNR consent signed by patients, documenting their preferences for withholding cardiopulmonary resuscitation (CPR), is a core element of advanced directives and a strong measure of patient autonomy on their end-of-life preferences
Summary
Global prevalence of chronic kidney disease (CKD) prevalence varies from 23–36%in people aged >64 years worldwide [1]. Objective: We aim to identify influential factors correlated with different donot-resuscitate consent types in patients with advanced kidney disease and the impact of do-notresuscitate consent types on various life-prolonging treatments. We included patients aged 20 years and over, diagnosed with advanced kidney disease and receiving palliative and hospice care consultation services between January 2014 and December 2018 in a tertiary teaching hospital in Taiwan. Do-not-resuscitate consents signed by patients were associated with reduced life-prolonging treatments including feeding tube placement and antibiotic use in the last seven days (odd ratio and 95% confidence interval were 0.16, 0.07–0.34 and 0.33, 0.16–0.69, respectively) compared to do-not-resuscitate consents signed by surrogates. Conclusions: Do-not-resuscitate consent signed by patients and not by surrogates may reflect better patients’ autonomy and reduced life-prolonging treatments in the final seven days of patients with advanced kidney disease
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