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

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dc.contributor Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP PEREIRA, Mariana B. FMUSP-HC
ZANETTA, Dirce M. T.
dc.identifier.citation PLOS ONE, v.7, n.10, article ID e47746, 11p, 2012
dc.identifier.issn 1932-6203
dc.description.abstract Background: 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.sponsorship · CAPES (""Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior'')
dc.language.iso eng
dc.relation.ispartof Plos One
dc.rights openAccess
dc.subject.other acute-renal-failure; acute myocardial-infarction; replacement therapy; peritubular capillaries; chronic dialysis; risk-factor; outcomes; death; survival; disease
dc.title The Real Importance of Pre-Existing Comorbidities on Long-Term Mortality after Acute Kidney Injury
dc.type article
dc.rights.holder Copyright PUBLIC LIBRARY SCIENCE
dc.identifier.doi 10.1371/journal.pone.0047746
dc.identifier.pmid 23082206
dc.type.category original article
dc.type.version publishedVersion PEREIRA, Mariana B.:FM: ABDULKADER, Regina C. R. M.:FM: · ZANETTA, Dirce M. T.:Univ Sao Paulo, Sch Publ Hlth, Dept Epidemiol, Sao Paulo, Brazil 2-s2.0-84867628543 WOS:000311146900103 SAN FRANCISCO USA
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dc.description.index MEDLINE
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hcfmusp.citation.wos 14 Brasil

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