The Real Importance of Pre-Existing Comorbidities on Long-Term Mortality after Acute Kidney Injury

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorPEREIRA, Mariana B.
dc.contributor.authorZANETTA, Dirce M. T.
dc.contributor.authorABDULKADER, Regina C. R. M.
dc.date.accessioned2013-07-30T17:53:33Z
dc.date.available2013-07-30T17:53:33Z
dc.date.issued2012
dc.description.abstractBackground: The causes of death on long-term mortality after acute kidney injury (AKI) have not been well studied. The purpose of the study was to evaluate the role of comorbidities and the causes of death on the long-term mortality after AKI. Methodology/Principal Findings: We retrospectively studied 507 patients who experienced AKI in 2005-2006 and were discharged free from dialysis. In June 2008 (median: 21 months after AKI), we found that 193 (38%) patients had died. This mortality is much higher than the mortality of the population of Sao Paulo City, even after adjustment for age. A multiple survival analysis was performed using Cox proportional hazards regression model and showed that death was associated with Khan's index indicating high risk [adjusted hazard ratio 2.54 (1.38-4.66)], chronic liver disease [1.93 (1.15-3.22)], admission to non-surgical ward [1.85 (1.30-2.61)] and a second AKI episode during the same hospitalization [1.74 (1.12-2.71)]. The AKI severity evaluated either by the worst stage reached during AKI (P=0.20) or by the need for dialysis (P=0.12) was not associated with death. The causes of death were identified by a death certificate in 85% of the non-survivors. Among those who died from circulatory system diseases (the main cause of death), 59% had already suffered from hypertension, 34% from diabetes, 47% from heart failure, 38% from coronary disease, and 66% had a glomerular filtration rate <60 previous to the AKI episode. Among those who died from neoplasms, 79% already had the disease previously. Conclusions: Among AKI survivors who were discharged free from dialysis the increased long-term mortality was associated with their pre-existing chronic conditions and not with the severity of the AKI episode. These findings suggest that these survivors should have a medical follow-up after hospital discharge and that all efforts should be made to control their comorbidities.
dc.description.indexMEDLINE
dc.description.sponsorshipCAPES (""Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior'')
dc.identifier.citationPLOS ONE, v.7, n.10, article ID e47746, 11p, 2012
dc.identifier.doi10.1371/journal.pone.0047746
dc.identifier.issn1932-6203
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/1552
dc.language.isoeng
dc.publisherPUBLIC LIBRARY SCIENCE
dc.relation.ispartofPlos One
dc.rightsopenAccess
dc.rights.holderCopyright PUBLIC LIBRARY SCIENCE
dc.subject.otheracute-renal-failure
dc.subject.otheracute myocardial-infarction
dc.subject.otherreplacement therapy
dc.subject.otherperitubular capillaries
dc.subject.otherchronic dialysis
dc.subject.otherrisk-factor
dc.subject.otheroutcomes
dc.subject.otherdeath
dc.subject.othersurvival
dc.subject.otherdisease
dc.subject.wosMultidisciplinary Sciences
dc.titleThe Real Importance of Pre-Existing Comorbidities on Long-Term Mortality after Acute Kidney Injury
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.author.externalZANETTA, Dirce M. T.:Univ Sao Paulo, Sch Publ Hlth, Dept Epidemiol, Sao Paulo, Brazil
hcfmusp.citation.scopus22
hcfmusp.contributor.author-fmusphcMARIANA BATISTA PEREIRA
hcfmusp.contributor.author-fmusphcREGINA CELIA RODRIGUES DE MORAES ABDULKADER
hcfmusp.description.articlenumbere47746
hcfmusp.description.issue10
hcfmusp.description.volume7
hcfmusp.origemWOS
hcfmusp.origem.pubmed23082206
hcfmusp.origem.scopus2-s2.0-84867628543
hcfmusp.origem.wosWOS:000311146900103
hcfmusp.publisher.citySAN FRANCISCO
hcfmusp.publisher.countryUSA
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