Abstract: PO1377
Dialysis Patients' Preferences on Resuscitation: A Cross-Sectional Study Design
Session Information
- Geriatric Nephrology: New Insights
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Geriatric Nephrology
- 1100 Geriatric Nephrology
Authors
- Alzayer, Husam, Galway University Hospitals, Galway, Ireland
- Geraghty, Annette M., Mayo University Hospital, Castlebar, Mayo, Ireland
- Sebastian, Kuruvilla Kallarackal, National University of Ireland Galway, Galway, Ireland
- Panesar, Hardarsh, Western University, London, Ontario, Canada
- Reddan, Donal N., Galway University Hospitals, Galway, Ireland
Background
End-stage kidney disease is associated with a 10-100-fold increase in cardiovascular mortality compared to age-, sex-, and race-matched population. Cardiopulmonary resuscitation (CPR) in this cohort has poor outcomes and is often followed by increased functional morbidity. Advance care planning (ACP) is an important aspect of patients' care that is often missed in chronic kidney disease (CKD) and there is growing support for its use. Nephrologists are often involved in end-of-life care decisions for their patients and frequent end-of-life care discussions can provide insight and valuable assistance to patients in the process of decision making.
Methods
2-center cross-sectional study design. Adults > 18 years undergoing regular dialysis for more than 3 months were included. Patients with severe cognitive impairment or unable to understand discussion secondary to language barrier were excluded. After taking consent, a questionnaire was delivered during a structured interview during a routine dialysis session or clinic visit. Demographic data were collected and baseline Montreal Cognitive Assessment, Patient Health Questionnaire-9, Duke Activity Status Index, Charlson Comorbidity Index, and Willingness to Accept Life-Sustaining Treatment tool were used.
Results
70 participants were included in this analysis representing a 62.5% response rate. There was a clear effect of treatment burden, nature of clinical outcome, and likelihood of the outcome on patients' preferences. Low-burden treatment resulting in return to baseline (vs death) was associated with 98.5% willingness to accept treatment and 94.2% if it was high-burden. When the outcome was severe functional or cognitive impairment then 54.3% and 71.5% would decline low-burden treatment, respectively. The response changed based on the likelihood of the outcome. In terms of resuscitation, 82.8% and 77.4% of the participants would be in favour of receiving CPR and mechanical ventilation, respectively, at their current health state. Over 94% of patients stated they had never discussed ACP while 59.4% expressed their wish to discuss this with their primary nephrologist.
Conclusion
ACP should be incorporated in managing CKD with an aim to improve communication and encourage patient and family involvement.