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Article
Use of do-not-resuscitate orders in patients with kidney disease hospitalized with acute myocardial infarction
Quantitative Health Sciences Publications and Presentations
  • Joline L.T. Chen, Boston University
  • Jonathan Sosnov, University of Miami
  • Darleen M. Lessard, University of Massachusetts Medical School
  • Jorge L. Yarzebski, University of Massachusetts Medical School
  • Joel M. Gore, University of Massachusetts Medical School
  • Robert J. Goldberg, University of Massachusetts Medical School
UMMS Affiliation
Department of Medicine, Division of Cardiovascular Medicine
Publication Date
1-23-2007
Document Type
Article
Subjects
Aged; Aged, 80 and over; Female; *Hospitalization; Humans; Kidney Diseases; Male; Myocardial Infarction; *Resuscitation Orders; Severity of Illness Index
Abstract

BACKGROUND: Patients with kidney disease are at increased risk for adverse health outcomes in comparison to patients without kidney disease. Therefore, patients with kidney disease may have greater use of do-not-resuscitate (DNR) orders than patients without kidney disease in the setting of an acute illness. We examined the association between advanced kidney disease and use of DNR orders in patients admitted with an acute myocardial infarction (AMI) to all greater Worcester, MA, hospitals as part of an epidemiological study.

METHODS: Use of DNR orders in 4,033 Worcester residents hospitalized with AMI at 11 greater Worcester medical centers during 1997, 1999, 2001, and 2003 was examined. Advanced kidney disease was defined on the basis of serum creatinine level at the time of hospital admission.

RESULTS: Forty-nine percent of patients with kidney disease and AMI had a DNR order in their medical records compared with 21% of patients without kidney disease. After controlling for a variety of potentially confounding factors, patients with kidney disease were more likely to have a DNR order than patients without kidney disease (adjusted odds ratio, 1.55; 95% confidence interval, 1.21 to 1.98). Patients with advanced kidney disease who received DNR orders were older, had more comorbid conditions, and were at greater risk for dying than patients with kidney disease without a DNR order.

CONCLUSION: Advanced kidney disease is associated with greater rates of DNR orders in patients hospitalized with AMI. Awareness of kidney disease may be an important consideration for patients and health care providers in discussing the use of DNR measures.

Rights and Permissions
Citation: Am J Kidney Dis. 2007 Jan;49(1):83-90. Link to article on publisher's site
PubMed ID
17185148
Related Resources
Link to Article in PubMed
Citation Information
Joline L.T. Chen, Jonathan Sosnov, Darleen M. Lessard, Jorge L. Yarzebski, et al.. "Use of do-not-resuscitate orders in patients with kidney disease hospitalized with acute myocardial infarction" Vol. 49 Iss. 1 (2007) ISSN: 0272-6386 (Linking)
Available at: http://works.bepress.com/jorge_yarzebski/11/