{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:31:16Z","timestamp":1786480276233,"version":"build-2736575974"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1R03DK113324"],"award-info":[{"award-number":["1R03DK113324"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["U54MD012530"],"award-info":[{"award-number":["U54MD012530"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2022,6,30]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Clinics caring for Black versus White cardiac arrest patients have significant differences in quality, resources, and patient case mix.<\/jats:p>\n <\/jats:list-item>\n \n Accounting for differences in clinic characteristics between Black versus White cardiac arrest patients did not reduce race disparities in cardiopulmonary resuscitation.<\/jats:p>\n <\/jats:list-item>\n \n Relative to younger patients, older Black patients were less likely to receive cardiopulmonary resuscitation in dialysis clinics compared with older White patients.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Cardiac arrest occurs frequently in outpatient dialysis clinics, and immediate cardiopulmonary resuscitation (CPR) provision improves patient outcomes. However, Black patients in dialysis clinics receive CPR from clinic staff less often compared with White patients. We examined the role of dialysis facility resources and patient factors in the observed racial disparity in CPR receipt and automated external defibrillator application.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This was a retrospective cohort study linking the National Cardiac Arrest Registry to Enhance Survival and Medicare Annual Dialysis Facility Report registries from 2013 to 2017. We identified patients experiencing cardiac arrests within US outpatient dialysis clinics\n via<\/jats:italic>\n geolocation matching (\n N<\/jats:italic>\n =1554). Differences in facility size, quality, staffing, and patient-related factors were summarized and compared according to patient race. Multilevel multivariable logistic regression models including these factors were used to examine the influence of these factors on the observed disparity in CPR rates between Black and White patients.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Compared with White patients, Black cardiac arrest patients dialyzed in larger facilities (26 versus 21 dialysis stations;\n P<\/jats:italic>\n <0.001), facilities with fewer registered nurses per station (0.29 versus 0.33;\n P<\/jats:italic>\n <0.001), and facilities with lower quality scores (# citations 6.8 versus 6.3;\n P<\/jats:italic>\n =0.04). Facilities treating Black patients cared for a higher proportion of patients with a history of cardiac arrest (41% versus 35%;\n P<\/jats:italic>\n <0.001), HIV\/hepatitis B, and Medicaid-enrolled patients (15% versus 11%;\n P<\/jats:italic>\n <0.001). Even after accounting for these differences and other covariates, the racial disparity for CPR in Black versus White patients persisted (OR=0.45; 95% CI, 0.27 to 0.75). The racial disparity in CPR was greater among older patients compared with younger patients (interaction\n P<\/jats:italic>\n =0.04).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The racial disparity in CPR delivery within dialysis clinics was not explained by differences in facility resources and quality. Reducing this disparity will require a multifaceted approach, including developing dialysis clinic-specific protocols for CPR and addressing potential implicit bias.<\/jats:p>\n <\/jats:sec>","DOI":"10.34067\/kid.0008092021","type":"journal-article","created":{"date-parts":[[2022,3,11]],"date-time":"2022-03-11T12:20:12Z","timestamp":1647001212000},"page":"1021-1030","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Facility-Level Factors and Racial Disparities in Cardiopulmonary Resuscitation within US Dialysis Clinics"],"prefix":"10.34067","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9896-8292","authenticated-orcid":false,"given":"Patrick H.","family":"Pun","sequence":"first","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina"},{"name":"Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3675-1282","authenticated-orcid":false,"given":"Laura P.","family":"Svetkey","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"McNally","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew E.","family":"Dupre","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina"},{"name":"Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina"},{"name":"Department of Sociology, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,6,30]]},"reference":[{"key":"B2-20250825","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1046\/j.1523-1755.1999.00391.x","article-title":"Sudden and cardiac death rates in hemodialysis patients","volume":"55","author":"Bleyer","year":"1999","journal-title":"Kidney Int"},{"key":"B3-20250825","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1046\/j.1523-1755.2001.00806.x","article-title":"Cardiac arrest and sudden death in dialysis units","volume":"60","author":"Karnik","year":"2001","journal-title":"Kidney Int"},{"key":"B4-20250825","doi-asserted-by":"crossref","first-page":"491","DOI":"10.2215\/CJN.02360706","article-title":"Predictors of survival after cardiac arrest in outpatient hemodialysis clinics","volume":"2","author":"Pun","year":"2007","journal-title":"Clin J Am Soc Nephrol"},{"key":"B5-20250825","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1001\/jama.2015.7938","article-title":"Association of bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in North Carolina, 2010\u20132013","volume":"314","author":"Malta Hansen","year":"2015","journal-title":"JAMA"},{"key":"B6-20250825","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1056\/NEJM200010263431701","article-title":"Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos","volume":"343","author":"Valenzuela","year":"2000","journal-title":"N Engl J Med"},{"key":"B7-20250825","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1681\/ASN.2018090911","article-title":"Outcomes for hemodialysis patients given cardiopulmonary resuscitation for cardiac arrest at outpatient dialysis clinics","volume":"30","author":"Pun","year":"2019","journal-title":"J Am Soc Nephrol"},{"key":"B8-20250825","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.resuscitation.2020.07.036","article-title":"Association between patient race and staff resuscitation efforts after cardiac arrest in outpatient dialysis clinics: A study from the CARES surveillance group","volume":"156","author":"Hofacker","year":"2020","journal-title":"Resuscitation"},{"key":"B9-20250825","doi-asserted-by":"crossref","first-page":"1562","DOI":"10.1111\/ajt.12749","article-title":"Dialysis facility and network factors associated with low kidney transplantation rates among United States dialysis facilities","volume":"14","author":"Patzer","year":"2014","journal-title":"Am J Transplant"},{"key":"B10-20250825","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1053\/j.ajkd.2019.08.023","article-title":"Arteriovenous fistula use in the United States and dialysis facility-level comorbidity burden","volume":"75","author":"Dahlerus","year":"2020","journal-title":"Am J Kidney Dis"},{"key":"B11-20250825","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.resuscitation.2018.10.006","article-title":"Comorbidity and survival in out-of-hospital cardiac arrest","volume":"133","author":"Hirlekar","year":"2018","journal-title":"Resuscitation"},{"key":"B12-20250825","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1136\/heartjnl-2019-315954","article-title":"Comorbidity and bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest","volume":"106","author":"Hirlekar","year":"2020","journal-title":"Heart"},{"key":"B13-20250825","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1016\/j.annemergmed.2009.03.018","article-title":"CARES: Cardiac Arrest Registry to Enhance Survival","volume":"54","author":"McNally","year":"2009","journal-title":"Ann Emerg Med"},{"key":"B14-20250825","first-page":"1","article-title":"Out-of-hospital cardiac arrest surveillance\u2014Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005\u2013December 31, 2010","volume":"60","author":"McNally","year":"2011","journal-title":"MMWR Surveill Summ"},{"key":"B15-20250825","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1161\/CIR.0000000000000144","article-title":"Cardiac arrest and cardiopulmonary resuscitation outcome reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation","volume":"132","author":"Perkins","year":"2015","journal-title":"Circulation"},{"key":"B17-20250825","doi-asserted-by":"crossref","first-page":"2117","DOI":"10.1681\/ASN.2020040483","article-title":"Racial and ethnic disparities in seasonal influenza vaccination among dialysis facilities in the United States","volume":"31","author":"Danziger","year":"2020","journal-title":"J Am Soc Nephrol"},{"key":"B18-20250825","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1001\/jama.2015.15281","article-title":"Multiple imputation: A flexible tool for handling missing data","volume":"314","author":"Li","year":"2015","journal-title":"JAMA"},{"key":"B19-20250825","first-page":"596","article-title":"CPR training and CPR performance: Do CPR-trained bystanders perform CPR?","volume":"13","author":"Swor","year":"2006","journal-title":"Acad Emerg Med"},{"key":"B21-20250825","doi-asserted-by":"crossref","first-page":"401","DOI":"10.37526\/1526-744X.2020.47.5.401","article-title":"Barriers and facilitators to performing cardiopulmonary resuscitation during treatment in outpatient hemodialysis clinics: A qualitative study","volume":"47","author":"Hofacker","year":"2020","journal-title":"Nephrol Nurs J"},{"key":"B22-20250825","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1177\/1474515117746329","article-title":"Age discrimination in out-of-hospital cardiac arrest care: A case-control study","volume":"17","author":"Wiel","year":"2018","journal-title":"Eur J Cardiovasc Nurs"},{"key":"B23-20250825","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.resuscitation.2021.02.003","article-title":"European Resuscitation Council Guidelines 2021: Executive summary [published correction appears in Resuscitation 163: 97\u201398, 2021 10.1016\/j.resuscitation.2021.04.012]","volume":"161","author":"Perkins","year":"2021","journal-title":"Resuscitation"},{"key":"B24-20250825","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.1111\/j.1532-5415.2008.01919.x","article-title":"What explains racial differences in the use of advance directives and attitudes toward hospice care?","volume":"56","author":"Johnson","year":"2008","journal-title":"J Am Geriatr Soc"},{"key":"B25-20250825","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1089\/jpm.2015.0326","article-title":"Racial and ethnic differences in advance directive possession: Role of demographic factors, religious affiliation, and personal health values in a national survey of older adults","volume":"19","author":"Huang","year":"2016","journal-title":"J Palliat Med"},{"key":"B26-20250825","doi-asserted-by":"crossref","first-page":"e60","DOI":"10.2105\/AJPH.2015.302903","article-title":"Implicit racial\/ethnic bias among health care professionals and its influence on health care outcomes: A systematic review","volume":"105","author":"Hall","year":"2015","journal-title":"Am J Public Health"},{"key":"B27-20250825","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1007\/s11606-013-2441-1","article-title":"Physicians and implicit bias: How doctors may unwittingly perpetuate health care disparities","volume":"28","author":"Chapman","year":"2013","journal-title":"J Gen Intern Med"},{"key":"B28-20250825","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1007\/s11606-007-0258-5","article-title":"Implicit bias among physicians and its prediction of thrombolysis decisions for Black and White patients","volume":"22","author":"Green","year":"2007","journal-title":"J Gen Intern Med"},{"key":"B29-20250825","doi-asserted-by":"crossref","first-page":"988","DOI":"10.2105\/AJPH.2011.300621","article-title":"The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: Pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma","volume":"102","author":"Sabin","year":"2012","journal-title":"Am J Public Health"},{"key":"B31-20250825","doi-asserted-by":"crossref","first-page":"772","DOI":"10.2215\/CJN.09920917","article-title":"Awareness of racial disparities in kidney transplantation among health care providers in dialysis facilities","volume":"13","author":"Kim","year":"2018","journal-title":"Clin J Am Soc Nephrol"},{"key":"B32-20250825","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1016\/j.jesp.2012.06.003","article-title":"Long-term reduction in implicit race bias: A prejudice habit-breaking intervention","volume":"48","author":"Devine","year":"2012","journal-title":"J Exp Soc Psychol"},{"key":"B33-20250825","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1007\/s11606-007-0160-1","article-title":"Reducing racial bias among health care providers: Lessons from social-cognitive psychology","volume":"22","author":"Burgess","year":"2007","journal-title":"J Gen Intern Med"},{"key":"B34-20250825","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1097\/ACM.0000000000002995","article-title":"Toward cultural competency in health care: A scoping review of the diversity and inclusion education literature","volume":"95","author":"Brottman","year":"2020","journal-title":"Acad Med"},{"key":"B35-20250825","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/s40615-017-0350-4","article-title":"The effects of race and racial concordance on patient-physician communication: A systematic review of the literature","volume":"5","author":"Shen","year":"2018","journal-title":"J Racial Ethn Health Disparities"}],"container-title":["Kidney360"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0008092021","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:01:26Z","timestamp":1786478486000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0008092021"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,30]]},"references-count":31,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.34067\/kid.0008092021","relation":{},"ISSN":["2641-7650"],"issn-type":[{"value":"2641-7650","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,30]]},"assertion":[{"value":"2021-12-14","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-03-09","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}