Abstract
Objectives
Despite significant improvements in renal management the mortality associated with dialysis care remains high. Many renal registries report mortality statistics on an annual basis. The objectives of this study were (1) to establish the accuracy of the registered cause of death (CoD) against that determined by a panel of physicians; and (2) to test the feasibility of using the HEMO study CoD classification system in patients on peritoneal dialysis (PD).
Setting
Single centre tertiary-care hospital.
Patients and methods
Patients were selected from those aged ≥ 65 years who died while receiving PD. The CoD was identified from that registered with the local renal registry, and from clinical records.
Main outcome measures
(1) Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and kappa score comparing registered and extracted CoD. (2) The proportions of deaths in seven categories using two classification systems.
Results
A total of 51 patient charts were reviewed. The agreement between the registered and extracted CoD was poor for all causes of death except malignancy. Kappa scores ranged from 0.55 to 1.0 for different causes. PPV were poor for all except malignancy. Comparison of the CoD was highly dependent on the classification method used (e.g., death secondary to infection was 4% and 25% for CORR and HEMO, respectively).
Conclusions
The registered CoD for patients who die while on PD is often inaccurate. Different policies for classifying deaths can have a significant effect on the final reports, which show the proportion of deaths attributed to different diseases. Standardization across registries is required.
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References
Canadian Institute for Health Information. 2002 CORR Preliminary report: preliminary statistics on renal failure and solid organ transplantation in Canada. 2002. Ottawa, Ontario
Woo KT (1993) The Singapore renal registry: an overview. Singapore Med J 34(2):157–163
Feest TG, Rajamahesh J, Byrne C, Ahmad A, Ansell D, Burden R, et al (2005) Trends in adult renal replacement therapy in the UK: 1982–2002. QJM 98(1):21–28
USRDS 2004 Annual data report. Am J Kidney Dis 2005; 45(1 Pt 2):8–280
Erek E, Suleymanlar G, Serdengecti K (2002) Nephrology, dialysis and transplantation in Turkey. Nephrol Dial Transplant 17(12):2087–2093
Conte F, Cappelli G, Casino F, Postorino M, Quintaliani G, Salomone M, et al (2004) Italian Registry of Dialysis and Transplantation: 1996–2001 experience. G␣Ital Nefrol 21(6):561–567
Jager KJ, van Dijk PC, Dekker FW, Stengel B, Simpson K, Briggs JD (2003) The epidemic of aging in renal replacement therapy: an update on elderly patients and their outcomes. Clin Nephrol 60(5):352–360
Centers for Medicare and Medicaid Services. http://www.cms.hhs.gov/providers/esrd.asp. 3–3-2005
Rocco MV, Yan G, Gassman J, Lewis JB, Ornt D, Weiss B, et al (2002) Comparison of causes of death using HEMO Study and HCFA end-stage renal disease death notification classification systems. The National Institutes of Health-funded Hemodialysis. Health Care Financing Administration. Am J Kidney Dis 39(1):146–153
Li SQ, Cass A, Cunningham J (2003) Cause of death in patients with end-stage renal disease: assessing concordance of death certificates with registry reports. Aust N Z J Public Health 27(4):419–424
Perneger TV, Klag MJ, Whelton PK (1993) Cause of death in patients with end-stage renal disease: death certificates vs registry reports. Am J Public Health 83(12):1735–1738
Modelmog D, Rahlenbeck S, Trichopoulos D (1992) Accuracy of death certificates: a population-based, complete-coverage, one-year autopsy study in East Germany. Cancer Causes Control 3(6):541–546
Grubb GS, Fortney JA, Saleh S, Gadalla S, el Baz A, Feldblum P, et al (1988) A comparison of two cause-of-death classification systems for deaths among women of reproductive age in Menoufia, Egypt. Int J Epidemiol 17(2):385–391
Lloyd-Jones DM, Martin DO, Larson MG, Levy D (1998) Accuracy of death certificates for coding coronary heart disease as the cause of death. Ann Intern Med 129(12):1020–1026
Muhlhauser I, Sawicki PT, Blank M, Overmann H, Richter B, Berger M (2002) Reliability of causes of death in persons with Type I diabetes. Diabetologia 45(11):1490–1497
Goraya TY, Jacobsen SJ, Belau PG, Weston SA, Kottke TE, Roger VL (2000) Validation of death certificate diagnosis of out-of-hospital coronary heart disease deaths in Olmsted County, Minnesota. Mayo Clin Proc 75(7):681–687
Maitra S, Jassal SV, Shea J, Chu M, Bargman JM (2001) Increased mortality of elderly female peritoneal dialysis patients with diabetes—a descriptive analysis. Adv Perit Dial 17:117–121
Lakkireddy DR, Gowda MS, Murray CW, Basarakodu KR, Vacek JL (2004) Death certificate completion: how well are physicians trained and are cardiovascular causes overstated?. Am J Med 117(7):492–498
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Maitra, S., Sekercioglu, N., Baloch, S. et al. Causes of death in older peritoneal dialysis patients—can we depend on registry reports?. Int Urol Nephrol 39, 345–350 (2007). https://doi.org/10.1007/s11255-006-9032-6
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DOI: https://doi.org/10.1007/s11255-006-9032-6