Causes of Death after a Hospitalization with AKI : Journal of the American Society of Nephrology (original) (raw)

Clinical Epidemiology

Silver, Samuel A.1; Harel, Ziv2,3,4; McArthur, Eric4; Nash, Danielle M.4; Acedillo, Rey5; Kitchlu, Abhijat2; Garg, Amit X.4,5; Chertow, Glenn M.6; Bell, Chaim M.4,7,8; Wald, Ron2,3,4

1Division of Nephrology, Kingston Health Sciences Center, Queen’s University, Kingston, Ontario, Canada;

2Division of Nephrology, St. Michael’s Hospital,

3Li Ka Shing Knowledge Institute of St Michael’s Hospital,

7Department of Medicine, Mount Sinai Hospital, and

8Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada;

4Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada;

5Division of Nephrology, London Health Sciences Centre, Western University, London, Ontario, Canada; and

6Division of Nephrology, Stanford University School of Medicine, Palo Alto, California

C.M.B. and R.W. contributed equal supervision to this work.

Correspondence: Dr. Samuel A. Silver, Division of Nephrology, Queen’s University, 76 Stuart Street, 3-Burr 21-3-039, Kingston, ON, Canada, K7L 3N6. Email: [email protected]

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.