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Causes of Death after a Hospitalization with AKI.

Authors
  • Silver, Samuel A1
  • Harel, Ziv2, 3, 4
  • McArthur, Eric4
  • Nash, Danielle M4
  • Acedillo, Rey5
  • Kitchlu, Abhijat2
  • Garg, Amit X4, 5
  • Chertow, Glenn M6
  • Bell, Chaim M4, 7, 8
  • Wald, Ron2, 3, 4
  • 1 Division of Nephrology, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada; [email protected] , (Canada)
  • 2 Division of Nephrology, St. Michael's Hospital.
  • 3 Li Ka Shing Knowledge Institute of St Michael's Hospital.
  • 4 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. , (Canada)
  • 5 Division of Nephrology, London Health Sciences Centre, Western University, London, Ontario, Canada; and. , (Canada)
  • 6 Division of Nephrology, Stanford University School of Medicine, Palo Alto, California.
  • 7 Department of Medicine, Mount Sinai Hospital, and.
  • 8 Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada. , (Canada)
Type
Published Article
Journal
Journal of the American Society of Nephrology
Publisher
American Society of Nephrology
Publication Date
Mar 01, 2018
Volume
29
Issue
3
Pages
1001–1010
Identifiers
DOI: 10.1681/ASN.2017080882
PMID: 29242248
Source
Medline
Keywords
License
Unknown

Abstract

Mortality after AKI is high, but the causes of death are not well described. To better understand causes of death in patients after a hospitalization with AKI and to determine patient and hospital factors associated with mortality, we conducted a population-based study of residents in Ontario, Canada, who survived a hospitalization with AKI from 2003 to 2013. Using linked administrative databases, we categorized cause of death in the year after hospital discharge as cardiovascular, cancer, infection-related, or other. We calculated standardized mortality ratios to compare the causes of death in survivors of AKI with those in the general adult population and used Cox proportional hazards modeling to estimate determinants of death. Of the 156,690 patients included, 43,422 (28%) died in the subsequent year. The most common causes of death were cardiovascular disease (28%) and cancer (28%), with respective standardized mortality ratios nearly six-fold (5.81; 95% confidence interval [95% CI], 5.70 to 5.92) and eight-fold (7.87; 95% CI, 7.72 to 8.02) higher than those in the general population. The highest standardized mortality ratios were for bladder cancer (18.24; 95% CI, 17.10 to 19.41), gynecologic cancer (16.83; 95% CI, 15.63 to 18.07), and leukemia (14.99; 95% CI, 14.16 to 15.85). Along with older age and nursing home residence, cancer and chemotherapy strongly associated with 1-year mortality. In conclusion, cancer-related death was as common as cardiovascular death in these patients; moreover, cancer-related deaths occurred at substantially higher rates than in the general population. Strategies are needed to care for and counsel patients with cancer who experience AKI.

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