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Abstract: PO1222

Code Status Variability in a Regional Hemodialysis Program

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Moorman, Danielle, Queen's University, Kingston, Ontario, Canada
  • Silver, Samuel A., Queen's University, Kingston, Ontario, Canada
  • Welihinda, Hasitha, Queen's University, Kingston, Ontario, Canada
  • Iliescu, Eduard A., Queen's University, Kingston, Ontario, Canada
Background

Patients with end stage kidney disease (ESKD) treated with hemodialysis (HD) have poor life expectancy and may not benefit from aggressive measures at the end of life. Previous studies suggest variability in Do Not Resuscitate (DNR) orders in patients treatd with HD but they are limited by missing code statuses and inability to adjust for demographics. In our regional HD program, with complete code status ascertainment that is updated annually, our objective was to examine DNR variability while accounting for demographic factors.

Methods

We conducted a cross-sectional study of DNR prevalence in October 2019 in patients treated with in-centre HD in a regional program, which consists of a main centre and six smaller centers. Patients are transferred to smaller centres based on location. Each centre has an attending nephrologist who reviews code status yearly with every patient. Unadjusted DNR prevalance are compared using the Chi-square test and multiple logistic regression is used to control for covariates (age, sex, race, dialysis vintage, HD unit).

Results

We included 374 patients, 193 (52%) from the main centre and 181 (48%) from its satelite units. Mean age of patients is 67.2±14.3 years, 52% male, 87% Caucasian, and dialysis vintage 5.2±5.5 years. Code status was full code in 78% and DNR in 22% with significant variation across sites (range of 9% to 44%, p = 0.02) (Figure 1). Variation remained significant (p = 0.03) after controlling for covariates.

Conclusion

Variability in code status at different HD centres in our regional program persisted despite accounting for differences in patient age, sex, race, and HD vintage. This finding suggests factors related to the HD centre may affect code status decisions, such as local culture, question phrasing, and views of the treating nephrologist. Future studies are planned to determine if a standardized approach to discussing code status would normalize rates.

Figure 1: Unadjusted DNR prevalence in hemodialysis units across a regional dialysis program.