Introduction

Chronic kidney failure is a health condition that affects millions of individuals worldwide, requiring life-sustaining treatments such as hemodialysis. However, hemodialysis patients are at an increased risk of cardiovascular disease and events, making the conversation around the use of cardiopulmonary resuscitation (CPR) in such instances both critical and complex. Research by Patrick H. Pun and colleagues at the Duke Clinical Research Institute, highlighted in the Journal of the American Society of Nephrology, delves into the outcomes for hemodialysis patients given CPR for cardiac arrest at outpatient dialysis clinics.

The Study and Its Findings

The study, authored by Pun et al. and supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), was a letter published in the JASN in response to previous research. It addressed the effectiveness and consequences of CPR for hemodialysis patients. This research is pivotal because hemodialysis patients have been historically excluded from many CPR outcome studies despite their high risk for cardiac events.

Using a matched cohort study design, Pun and his team examined the real-world outcomes for end-stage kidney disease patients on dialysis after having undergone CPR for cardiac arrest. What their research revealed is sobering: these patients tend to have higher mortality rates post-CPR compared to those without chronic kidney failure. Importantly, this research provides empirical evidence that can guide clinicians in shared decision-making processes with hemodialysis patients concerning CPR.

The outcomes also raise crucial ethical and practical discussions about the appropriateness of CPR in these patients, the preparedness of outpatient dialysis clinics in handling such emergencies, and how advanced care planning can be improved.

Implications for Clinical Practices

The findings by Pun et al. inform medical practitioners and patients about the statistical outcomes of CPR in hemodialysis contexts, emphasizing the need for transparent and informed discussions regarding resuscitation preferences. They underscore the importance of personalized care plans that take into account individual patient values and the likely clinical outcomes.

References and Further Reading

To substantiate the complex nature of this topic, several references emphasize different aspects of the discussion:
1. Malta Hansen et al., 2015, explored the role of bystander and first-responder intervention in survival rates after out-of-hospital cardiac arrests.
2. Kragholm et al., 2015, investigated the return to work in out-of-hospital cardiac arrest survivors.
3. Holley et al., 1989, and Moss et al., 2001, contributed to understanding dialysis patients’ attitudes toward CPR and stopping dialysis treatments.
4. Bardy et al., 2005, provided insights into the use of amiodarone or implantable cardioverter-defibrillators for heart failure, relevant to the prevention of sudden cardiac death in these patients.
5. Wetmore et al., 2018, offered perspectives on the state of care for dialysis patients and the areas that require improvement.

Conclusion

The discourse around the use of CPR in hemodialysis patients is multifaceted and requires considerations far beyond the immediate clinical response. The article by Pun et al. adds to the growing body of knowledge, emphasizing the critical role of empirical evidence in guiding ethical and clinical decisions. The dialogue is far from over, as there remain many avenues to explore in the quest to improve care for dialysis patients.

Keywords

1.  Hemodialysis Cardiac Arrest
2.  CPR Chronic Kidney Failure
3.  Dialysis CPR Outcomes
4.  End-Stage Renal Disease CPR
5.  Dialysis Clinic Resuscitation

DOI

Pun, Patrick H., et al. “Authors’ Reply.” Journal of the American Society of Nephrology: JASN, vol. 30, no. 6, 2019, pp. 1137-1138, doi:10.1681/ASN.2019040353.