The Detrimental Impact of End-Stage Kidney Disease Is Not Reflected in Autopsy Reports.

IF 3.7 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY
Gabriel B Lerner, Meredith A Reynolds, Suman Setty, Reem Deeb, Prerna Rastogi, Gilbert Moeckel, Harold Sanchez, Kammi J Henriksen, Anthony Chang
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Abstract

Context.—: End-stage kidney disease (ESKD) is defined as renal impairment requiring renal replacement therapy to sustain life. With a 1-year mortality of ∼20% to 30%, many die of complications related to this disease.

Objective.—: To determine the percentage of autopsy cases of decedents with ESKD in which the contribution of ESKD to death is accurately reflected in the final report.

Design.—: Autopsy case records were retrospectively reviewed at 4 institutions (Yale New Haven Hospital, University of Chicago Medical Center, University of Illinois at Chicago Hospital, University of Iowa Hospital). Clinical, macroscopic, and microscopic autopsy findings were reviewed, with attention to renal disease findings.

Results.—: One hundred sixty decedents with documented ESKD and premortem dialysis who underwent autopsy assessment were identified. ESKD was implicated as a cause of death (CoD) or significant contributing factor in 44 cases (28%), but not in the remaining 116 cases (72%). Cardiovascular disease was the most common CoD in ESKD. There was significant interpathologist variation in the inclusion of ESKD as a CoD across institutions. These rates ranged from 85% correlation (23 of 27 cases), to 13% (4 of 31 and 8 of 62 cases at 2 institutions), and 22.5% (9 of 40 cases) across the 4 participating institutions.

Conclusions.—: The recognition at autopsy of ESKD as a CoD or contributing CoD at autopsy in patients undergoing dialysis remains low (28%). The detrimental impact of ESKD is not reflected in hospital autopsy reports, which carries implications for collection of vital statistics and allocation of research funding for kidney diseases.

终末期肾病的有害影响并未反映在尸检报告中。
背景终末期肾病(ESKD)是指需要通过肾脏替代治疗来维持生命的肾功能损伤。ESKD的1年死亡率为20%至30%,许多患者死于与该疾病相关的并发症:确定最终报告中准确反映 ESKD 导致死亡的 ESKD 死者尸检病例的百分比:对 4 家机构(耶鲁大学纽黑文医院、芝加哥大学医学中心、伊利诺伊大学芝加哥医院、爱荷华大学医院)的尸检病例记录进行回顾性审查。回顾了临床、宏观和微观尸检结果,并关注了肾脏疾病的发现:结果:确定了 160 位接受尸检评估、有 ESKD 和死前透析记录的死者。44例(28%)的ESKD是死因或重要诱因,其余116例(72%)的ESKD不是死因或重要诱因。心血管疾病是 ESKD 最常见的死因。不同机构的病理学家在将 ESKD 作为 CoD 时存在很大差异。这些比率从85%的相关性(27例中的23例)到13%的相关性(2家机构的31例中的4例和62例中的8例),以及4家参与机构的22.5%的相关性(40例中的9例)不等:在接受透析的患者中,尸检时将 ESKD 识别为 CoD 或促成 CoD 的比例仍然很低(28%)。ESKD的不利影响并未反映在医院的尸检报告中,这对生命统计数据的收集和肾脏疾病研究资金的分配产生了影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
9.20
自引率
2.20%
发文量
369
审稿时长
3-8 weeks
期刊介绍: Welcome to the website of the Archives of Pathology & Laboratory Medicine (APLM). This monthly, peer-reviewed journal of the College of American Pathologists offers global reach and highest measured readership among pathology journals. Published since 1926, ARCHIVES was voted in 2009 the only pathology journal among the top 100 most influential journals of the past 100 years by the BioMedical and Life Sciences Division of the Special Libraries Association. Online access to the full-text and PDF files of APLM articles is free.
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