Incidence and Outcomes of in-Hospital Cardiac Arrest and Cardiopulmonary Resuscitation in the Kidney Replacement Therapy Population: Protocol for a Linked National Disease Registry Study.

Background: Every patient receiving kidney replacement therapy that is, hemodialysis, 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 kidney replacement therapy 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 influences how kidney replacement therapy recipients, their families and care providers make informed discussions on CPR status and may leave kidney replacement therapy recipients vulnerable to false assumptions of poor suitability. Objective: Our primary objective is to calculate the incidence and survival rates of in-hospital CPR in the kidney replacement therapy population in England over a 10-year period (2012-2022). Further, we aim to compare the characteristics of survivors versus nonsurvivors, and describe neurological outcomes. Methods: We will conduct a retrospective cohort study of patients receiving kidney replacement therapy aged≥28 days in England who underwent in-hospital CPR between 2012 and 2022. Individuals receiving kidney replacement therapy will be identified as reported to the United Kingdom Renal Registry (UKRR). Case matching will occur between The UKRR and The Intensive Care National Audit & Research Center (ICNARC) which holds the UK National Cardiac Arrest Audit (NCAA) database. The annual cumulative incidence of in-hospital CPR events will be ascertained by kidney replacement therapy modality. Survival and neurological outcomes will be reported aligned with international data reporting standards. The characteristics of survivors versus nonsurvivors and individuals with favorable versus individuals with nonfavorable neurological outcomes will be compared to identify individual or situational factors that associate with outcomes. Results: As of February 2026, ethical approval has been granted by The South West - Cornwall & Plymouth 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 kidney replacement therapy start) without consent between the UKRR and ICNARC, and date of death only between ICNARC and the University of Bristol 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 kidney replacement therapy population. This will provide patients, their loved ones, and care providers data on the likelihood of in-hospital CPR success which will aid the advanced care planning in this setting.