JMIR Publications

ABSTRACT

Background:

Background Every patient receiving kidney replacement therapy (KRT) i.e. haemodialysis, peritoneal dialysis or a kidney transplant, should have an advanced treatment escalation plan. This should include a decision on cardiopulmonary resuscitation (CPR) status. The existing literature suggests KRT recipients who undergo in-hospital CPR have outcomes similar to the general population. However, these data originate exclusively from North America and Taiwan, do not include transplant recipients, and neurological outcomes are poorly reported. This paucity of evidence is preventing KRT recipients, their families and care providers from having informed discussions on their CPR status. It also leaves KRT recipients vulnerable to false assumptions of poor suitability for CPR.

Objective:

Our primary objective is to calculate the incidence and survival rates of in-hospital CPR in the KRT population in England over a 10-year period (2012-2022). Further, we aim to compare the characteristics of survivors vs non-survivors and describe neurological outcomes.

Methods:

We will conduct a retrospective cohort study of patients receiving KRT aged ≥28 days in England that underwent in-hospital CPR between 2012 and 2022. Individuals receiving KRT will be identified as reported to the UK Renal Registry (UKRR). Case matching will occur between The UKRR and The Intensive Care National Audit & Research Centre (ICNARC) which holds the UK National Cardiac Arrest Audit (NCAA) database. The annual cumulative incidence of in-hospital CPR events will be ascertained by KRT modality. Survival and neurological outcomes will be reported aligned with international data reporting standards. The characteristics of survivors versus non-survivors and subjects with favourable, versus subjects with non-favourable neurological outcomes, will be compared respectively to identify individual or situational factors that associate with outcomes.

Results:

As of July 2025, ethical approval has been granted by The University of Bristol (UoB) Research Ethics Committee. Section 251 support has been granted to allow the processing of confidential information (limited to date of birth, NHS number and date of KRT start) without consent between the UKRR and ICNARC, and date of death only between ICNARC and the UoB researchers. This excludes individuals who have opted out of their data being used for research purposes by the UKRR

Conclusions:

By linking registry data this study will provide a whole-of-population approach to describing the incidence and outcomes of in-hospital CPR in the English KRT population. This will better inform patients, their loved ones and care providers of the likelihood of CPR success.