Causes of Death in End-Stage Kidney Disease: Comparison between the United States Renal Data System and a Large Integrated Health Care System

Simran K Bhandari; Hui Zhou; Sally F Shaw; Jiaxiao Shi; Natasha S Tilluckdharry; Connie M Rhee; Steven J Jacobsen; John J Sim

doi:10.1159/000520466

Causes of Death in End-Stage Kidney Disease: Comparison between the United States Renal Data System and a Large Integrated Health Care System

Am J Nephrol. 2022;53(1):32-40. doi: 10.1159/000520466. Epub 2022 Jan 11.

Authors

Simran K Bhandari^{1

2}, Hui Zhou^{3

4}, Sally F Shaw³, Jiaxiao Shi³, Natasha S Tilluckdharry⁵, Connie M Rhee⁶, Steven J Jacobsen³, John J Sim^{2

5}

Affiliations

¹ Department of Internal Medicine, Kaiser Permanente Downey Medical Center, Los Angeles, California, USA.
² Department of Clinical Science, Kaiser Permanente Bernard J Tyson Kaiser School of Medicine, Pasadena, California, USA.
³ Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
⁴ Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
⁵ Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA.
⁶ Division of Nephrology, University of California Irvine Medical Center, Orange, California, USA.

PMID: 35016183
DOI: 10.1159/000520466

Abstract

Introduction: Using a large diverse population of incident end-stage kidney disease (ESKD) patients from an integrated health system, we sought to evaluate the concordance of causes of death (CODs) between the underlying COD from the United States Renal Data System (USRDS) registry and CODs obtained from Kaiser Permanente Southern California (KPSC).

Methods: A retrospective cohort study was performed among incident ESKD patients who had mortality records and CODs reported in both KPSC and USRDS databases between January 1, 2007, and December 31, 2016. Underlying CODs reported by the KPSC were compared to the CODs reported by USRDS. Overall and subcategory-specific COD agreements were assessed using Cohen's weighted kappa statistic (95% CI). Proportions of positive and negative agreement were also determined.

Results: Among 4,188 ESKD patient deaths, 4,118 patients had CODs recorded in both KPSC and USRDS. The most common KPSC CODs were circulatory system diseases (35.7%), endocrine/nutritional/metabolic diseases (24.2%), genitourinary diseases (12.9%), and neoplasms (9.6%). Most common USRDS CODs were cardiac disease (46.9%), withdrawal from dialysis (12.6%), and infection (10.1%). Of 2,593 records with causes listed NOT as "Other," 453 (17.4%) had no agreement in CODs between the USRDS and the underlying, secondary, tertiary, or quaternary causes recorded by KPSC. In comparing CODs recorded within KPSC to the USRDS, Cohen's weighted kappa (95% CI) was 0.20 (0.18-0.22) with overall agreement of 36.4%.

Conclusion: Among an incident ESKD population with mortality records, we found that there was only fair or slight agreement between CODs reported between the USRDS registry and KPSC, a large integrated health care system.

Keywords: Cause of death; End-stage kidney disease; Health care system; Mortality; United States Renal Data System national registry.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cause of Death
Delivery of Health Care, Integrated*
Female
Humans
Kidney Failure, Chronic* / epidemiology
Kidney Failure, Chronic* / therapy
Male
Renal Dialysis
Retrospective Studies
United States / epidemiology