From the Department of Surgical Pathology, Yale University School of Medicine, New Haven, Connecticut (Lerner, Moeckel, Sanchez).
the Department of Pathology, University of Chicago School of Medicine, Chicago, Illinois (Reynolds, Henriksen, Chang).
Arch Pathol Lab Med. 2024 Jan 1;148(1):74-77. doi: 10.5858/arpa.2022-0338-OA.
CONTEXT.—: End-stage kidney disease (ESKD) is defined as renal impairment requiring renal replacement therapy to sustain life. With a 1-year mortality of ∼20% to 30%, many die of complications related to this disease.
OBJECTIVE.—: To determine the percentage of autopsy cases of decedents with ESKD in which the contribution of ESKD to death is accurately reflected in the final report.
DESIGN.—: Autopsy case records were retrospectively reviewed at 4 institutions (Yale New Haven Hospital, University of Chicago Medical Center, University of Illinois at Chicago Hospital, University of Iowa Hospital). Clinical, macroscopic, and microscopic autopsy findings were reviewed, with attention to renal disease findings.
RESULTS.—: One hundred sixty decedents with documented ESKD and premortem dialysis who underwent autopsy assessment were identified. ESKD was implicated as a cause of death (CoD) or significant contributing factor in 44 cases (28%), but not in the remaining 116 cases (72%). Cardiovascular disease was the most common CoD in ESKD. There was significant interpathologist variation in the inclusion of ESKD as a CoD across institutions. These rates ranged from 85% correlation (23 of 27 cases), to 13% (4 of 31 and 8 of 62 cases at 2 institutions), and 22.5% (9 of 40 cases) across the 4 participating institutions.
CONCLUSIONS.—: The recognition at autopsy of ESKD as a CoD or contributing CoD at autopsy in patients undergoing dialysis remains low (28%). The detrimental impact of ESKD is not reflected in hospital autopsy reports, which carries implications for collection of vital statistics and allocation of research funding for kidney diseases.
终末期肾病（ESKD）定义为需要肾脏替代治疗以维持生命的肾功能损害。由于 1 年内的死亡率约为 20%至 30%，许多人死于与该疾病相关的并发症。
确定尸检中患有 ESKD 的死者中，有多少例 ESKD 对死亡的贡献在最终报告中得到准确反映。
在 4 家机构（耶鲁纽黑文医院、芝加哥大学医学中心、伊利诺伊大学芝加哥医院、爱荷华大学医院）回顾性审查尸检病例记录。对临床、大体和显微镜下的尸检发现进行了回顾，重点关注肾脏疾病的发现。
确定了 160 例有记录的 ESKD 和生前透析的死者进行了尸检评估。ESKD 被认为是死因（CoD）或重要的促成因素的有 44 例（28%），但在其余 116 例（72%）中并非如此。心血管疾病是 ESKD 最常见的 CoD。不同机构的病理学家在将 ESKD 纳入 CoD 方面存在显著的差异。这些比率从 85%的相关性（27 例中的 23 例）到 13%（2 家机构的 31 例中的 4 例和 62 例中的 8 例）和 40 例中的 22.5%（9 例）不等。
在接受透析的患者中，尸检时将 ESKD 作为 CoD 或促成 CoD 的认识仍然较低（28%）。ESKD 的不良影响并未反映在医院尸检报告中，这对生命统计数据的收集和肾脏疾病研究资金的分配产生了影响。
