The South West Public Health Observatory (SWPHO) have produced a report on death from renal disease in England to support implementation of the national end of life care strategy. In the years 2001-2008, there were 175,917 deaths related to kidney disease. This represents approximately 5% of all deaths (3,865,264) recorded in England over the same period.
Chronic kidney disease (CKD) (94,520), acute kidney injury (AKI) (57,978) and renal cancer (25,877) were the most frequently mentioned kidney diseases. CKD and AKI have increased significantly over the period of the study. The report makes the point that if the cause of death is unrelated to the kidney condition eg death from a road traffic accident, then kidney disease isn’t recorded on the death certificate. So the number of recorded deaths related to kidney disease is not the same as the number of people dying with kidney disease. Most people with kidney disease don’t die from a road traffic accident, they mainly die from vascular events and we know from studies in Northern Ireland that even in people with quite advanced CKD (Stages 4 and 5), the kidney disease is often not mentioned in the death certificate. For example, among patients dying while receiving renal replacement therapy, only 17% had a primary cause of death coded for renal disease, 66% as a secondary code and 17% had no renal coding on the death certificate. In patients with a glomerular filtration rate of less than 15 mls min, renal disease was mentioned as the primary cause of death in only 8.5% and as a secondary cause in only a further 35%. So there is significant under recording of kidney disease on death certificates.
Nonetheless the 50% increase in deaths from CKD and the near doubling of AKI deaths should not be any cause for complacency.
We know in the general population that most people prefer to die at home. For people with renal cancer 25% died at home and another 25% died in a hospice or a nursing home. The corresponding figures for CKD are 9% and 6%; 81% of people with CKD died in hospital.
This report is the first of its kind and Julia Verne (Director, SWPHO) and her team are to be congratulated on a clear and thought provoking analysis. The next steps areTo look in more depth at the influences on place of death for each of the main kidney diseases
To look at the underlying causes of death where renal diseases are only mentioned as a secondary or non-contributory causes on the death certificate
To look at the pattern of admissions and type of care received in hospital during the last year of life for those dying in and out of hospital.