Kidney Week

Abstract: SA-OR101

Causes of Death in Patients Who Survive a Hospitalization with AKI

Session Information

• What Happens After AKI
  November 04, 2017 | Location: Room 295, Morial Convention Center
  Abstract Time: 04:30 PM - 04:42 PM

Category: Acute Kidney Injury

• 003 AKI: Clinical and Translational

Authors

• Silver, Samuel A., Queen's University, Kingston, Ontario, Canada

Samuel A. Silver, MD, MS



Samuel Silver is an Assistant Professor in the Division of Nephrology at Queen’s University. He completed his clinical training in internal medicine and nephrology at the University of Toronto. He holds a Master of Science in quality improvement and patient safety, and completed the Veteran Affairs Quality Scholars program at the University of California-San Francisco. Samuel then trained as a research fellow at Stanford University, with a focus on health services research and acute kidney injury. His research focuses on the delivery of care for patients with acute kidney injury, both during the inpatient and outpatient setting.

• Harel, Ziv, St. Michael's Hospital, Toronto, Ontario, Canada

Ziv Harel,

• McArthur, Eric, Institute for Clinical Evaluative Sciences, London, Ontario, Canada

Eric McArthur,

• Nash, Danielle Marie, London Health Sciences Centre, London, Ontario, Canada

Danielle Marie Nash,

• Acedillo, Rey R., Kingston Health Sciences Centre, Kingston, Ontario, Canada

Rey R. Acedillo,

• Kitchlu, Abhijat, University of Toronto, Toronto, Ontario, Canada

Abhijat Kitchlu,

• Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada

Amit X. Garg,

• Chertow, Glenn Matthew, Stanford University School of Medicine, Palo Alto, California, United States

Glenn Matthew Chertow,

• Wald, Ron, St. Michael's Hospital, Toronto, Ontario, Canada

Ron Wald,

Background

Mortality after an acute kidney injury (AKI) episode is high, but the causes of death are not well described. We sought to better understand causes of death in patients who survive a hospitalization with AKI, and hypothesized that cardiovascular disease would account for most deaths after hospital discharge.

Methods

We conducted a population-based study of residents in Ontario, Canada, who survived a hospitalization with AKI from 2003-2013. We defined AKI with validated ICD-10 diagnosis codes. Using linked administrative databases, we categorized cause of death in the year following hospital discharge as cardiovascular, cancer, infection-related, or other. We calculated standardized mortality ratios (SMR) to compare the cause of death in survivors of AKI to the general adult population, and used Cox proportional hazards modeling to estimate determinants of death.

Results

Of the 156,690 patients discharged after an AKI episode, 43,422 (28%) died in the subsequent year. The most common causes of death were cardiovascular disease (28%) and cancer (28%), with respective SMRs nearly six-fold (5.81, 95% CI 5.70-5.92) and nearly eight-fold (7.87, 95% CI 7.72-8.02) higher relative to the general population. The highest SMRs were for cancer-related mortality, specifically bladder cancer (18.24, 95% CI 17.10-19.41), gynecologic cancer (16.83, 95% CI 15.63-18.07), and leukemia (14.99, 95% CI 14.16-15.85). In addition to older age and nursing home residence, factors most strongly associated with one-year mortality were cancer (hazard ratio [HR] 1.62, 95% CI 1.58-1.65) and inpatient chemotherapy (2.03, 95% CI 1.90-2.17).

Conclusion

Among survivors of a hospitalization with AKI, cancer-related death was as common as cardiovascular death; moreover, cancer-related deaths occurred at the highest rates relative to the general adult population. In addition to modifying the risk of subsequent cardiovascular disease, strategies are needed to care for and counsel patients with cancer who experience AKI.