Causes of death across categories of estimated glomerular filtration rate: The Stockholm CREAtinine Measurements (SCREAM) project

• Published in: PloS one Vol. 14; no. 1; p. e0209440
• Main Authors: Runesson, Björn, Qureshi, Abdul R, Xu, Hong, Gasparini, Alessandro, Lindholm, Bengt, Barany, Peter, Elinder, Carl G, Carrero, Juan J
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 2019; Public Library of Science (PLoS)
• Subjects: Aged; Aged, 80 and over; Biology and Life Sciences; Cancer; Cardiovascular disease; Cardiovascular diseases; Cause of Death; Cohort Studies; Congestive heart failure; Coronary artery disease; Creatinine; Creatinine - blood; Death; Diabetes; Diabetes mellitus; Epidemiology; Epidermal growth factor receptors; Fatalities; Female; Glomerular Filtration Rate; Health care; Health services; Heart diseases; Humans; Infections; Ischemia; Kidney diseases; Kidneys; Laboratories; Male; Management; Medical care; Medicin och hälsovetenskap; Medicine and Health Sciences; Middle Aged; Mortality; Patient outcomes; People and places; Planning; Prevention; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - physiopathology; Sweden - epidemiology; Sweden; United Kingdom > UK; England
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0209440

Reduced kidney function increases the risk of death, but there is limited information on causes of death across stages of chronic kidney disease (CKD). We aimed to identify leading causes of death in community-dwelling individuals with differing kidney function. Observational analysis from SCREAM, a healthcare utilization cohort of Stockholm, Sweden. We included all individuals who died during 2006-2012 and had one serum creatinine measured in the year prior to death. Using the CKD-EPI formula, we calculated eGFR and stratified individuals according to CKD stages. Causes of death were classified as cardiovascular (CVD), cancer, infection and other, using ICD-10 codes. We compared age- and sex-adjusted differences in the proportions of deaths from each cause. Out of 89,117 registered deaths, 70,547 (79%) had a recent eGFR estimation and were included in this study. Individuals had a median age of 82 (IRE 62-93) years and 52% were women. The proportions of deaths from CVD increased with lower eGFR, along with the proportion of deaths from infections. Deaths due to diabetes and genito-urinary diseases increased. Deaths due to cancer decreased, but other death causes did not vary. Within CVD causes of death, the proportion of arrhythmias and heart failure increased, but ischemic heart disease and cerebrovascular disease remained stable. In a region-representative Swedish healthcare extraction, we observe differences regarding specific causes of death across different CKD stages. Increasing patient and provider awareness of this differential pattern of risk may have benefits for patient management, prevention strategies, and health service planning.