End-Stage Kidney Disease Is Overlooked as a Proximate Cause of Death at Autopsy

Abstract

Abstract Objectives To determine how often end-stage kidney disease (ESKD) is implicated as a cause of death (COD) at autopsy. Methods We searched our autopsy database (2007-2017) using queries “end-stage renal disease,” “end-stage kidney disease,” “ESRD,” “chronic renal disease,” and “chronic kidney disease.” Final diagnosis and summaries were reviewed to determine if ESKD was appropriately correlated with the COD. Cases in which the COD was unrelated to kidney function were excluded. Results Eighty-five patients with a history of ESKD and histologic confirmation thereof were identified. Their CODs were cardiovascular (36%), infection/sepsis (41%), pulmonary (6%), gastrointestinal/hepatic (2%), central nervous system (3%), other systemic disease (7%), and unspecified (5%). ESKD was implicated as a contributing COD in 24 (28%) cases. Conclusions ESKD is often overlooked at autopsy, particularly in patients with cardiovascular or infectious disease. Accurate documentation of ESKD contributing to mortality is important for education, counseling, record maintenance, and directing research efforts.