Charlson Comorbidity Score is a Strong Predictor of Mortality in Hemodialysis Patients

Overview

Journal Int Urol Nephrol

Publisher Springer

Specialty Nephrology

Date 2011 Dec 3

PMID 22134841

Citations 50

Authors

Manoch Rattanasompattikul

Usama Feroze

Miklos Z Molnar

Ramanath Dukkipati

Csaba P Kovesdy

Allen R Nissenson

Keith C Norris

Joel D Kopple

Kamyar Kalantar-Zadeh

Affiliations

Soon will be listed here.

Abstract

Purpose: The Charlson comorbidity index (CCI) is a commonly used scale for assessing morbidity, but its role in assessing mortality in hemodialysis patients is not clear. Age, a component of CCI, is a strong risk factor for morbidity and mortality in chronic diseases and correlates with comorbidities. We hypothesized that the Charlson comorbidity index without age is a strong predictor of mortality in hemodialysis patients.

Methods: A 6-year cohort of 893 hemodialysis patients was examined for an association between a modified CCI (without age and kidney disease) (mCCI) and mortality.

Results: Patients were 53±15 years old (mean±SD), had a median mCCI score of 2, and included 47% women, 31% African Americans and 55% diabetics. After adjusting for case-mix and nutritional and inflammatory markers including C-reactive protein and interleukin-6, 2nd (mCCI: 1-2), 3rd (mCCI=3), and 4th (mCCI: 4-9) quartiles compared to 1st (mCCI=0) quartiles showed death hazard ratios (95% confidence intervals) of 1.43 (0.92-2.23), 1.70 (1.06-2.72), and 2.33 (1.43-3.78), respectively. The mCCI-death association was robust in non-African Americans. The CCI-death association linearity was verified in cubic splines. Each 1 unit higher mCCI score was associated with a death hazard ratio of 1.16 (1.07-1.27).

Conclusions: CCI independent of age is a robust and linear predictor of mortality in hemodialysis patients, in particular in non-African Americans.

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References

Williams A, McArley A . Body composition, treatment time, and outcome in hemodialysis patients. J Ren Nutr. 1999; 9(3):157-62. DOI: 10.1016/s1051-2276(99)90056-0. View

Miskulin D, Martin A, Brown R, Fink N, Coresh J, Powe N . Predicting 1 year mortality in an outpatient haemodialysis population: a comparison of comorbidity instruments. Nephrol Dial Transplant. 2004; 19(2):413-20. DOI: 10.1093/ndt/gfg571. View

Di Iorio B, Cillo N, Cirillo M, De Santo N . Charlson Comorbidity Index is a predictor of outcomes in incident hemodialysis patients and correlates with phase angle and hospitalization. Int J Artif Organs. 2004; 27(4):330-6. DOI: 10.1177/039139880402700409. View

Shantouf R, Budoff M, Ahmadi N, Ghaffari A, Flores F, Gopal A . Total and individual coronary artery calcium scores as independent predictors of mortality in hemodialysis patients. Am J Nephrol. 2010; 31(5):419-25. PMC: 2883846. DOI: 10.1159/000294405. View

Noori N, Kalantar-Zadeh K, Kovesdy C, Murali S, Bross R, Nissenson A . Dietary potassium intake and mortality in long-term hemodialysis patients. Am J Kidney Dis. 2010; 56(2):338-47. PMC: 2910783. DOI: 10.1053/j.ajkd.2010.03.022. View

Kalantar-Zadeh K, Dunne E, Nixon K, Kahn K, Lee G, Kleiner M . Near infra-red interactance for nutritional assessment of dialysis patients. Nephrol Dial Transplant. 1999; 14(1):169-75. DOI: 10.1093/ndt/14.1.169. View

Wright L . Survival in patients with end-stage renal disease. Am J Kidney Dis. 1991; 17(1):25-8. DOI: 10.1016/s0272-6386(12)80245-9. View

Ridker P, Rifai N, Rose L, Buring J, Cook N . Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002; 347(20):1557-65. DOI: 10.1056/NEJMoa021993. View

Beddhu S, Bruns F, Saul M, Seddon P, Zeidel M . A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients. Am J Med. 2000; 108(8):609-13. DOI: 10.1016/s0002-9343(00)00371-5. View

10.

Hall S . A user's guide to selecting a comorbidity index for clinical research. J Clin Epidemiol. 2006; 59(8):849-55. DOI: 10.1016/j.jclinepi.2005.11.013. View

11.

Keane W, Collins A . Influence of co-morbidity on mortality and morbidity in patients treated with hemodialysis. Am J Kidney Dis. 1994; 24(6):1010-8. DOI: 10.1016/s0272-6386(12)81076-6. View

12.

Mehrotra R, Kermah D, Fried L, Kalantar-Zadeh K, Khawar O, Norris K . Chronic peritoneal dialysis in the United States: declining utilization despite improving outcomes. J Am Soc Nephrol. 2007; 18(10):2781-8. DOI: 10.1681/ASN.2006101130. View

13.

Pecoits-Filho R, Barany P, Lindholm B, Heimburger O, Stenvinkel P . Interleukin-6 is an independent predictor of mortality in patients starting dialysis treatment. Nephrol Dial Transplant. 2002; 17(9):1684-8. DOI: 10.1093/ndt/17.9.1684. View

14.

Beutler B, Cerami A . The biology of cachectin/TNF--a primary mediator of the host response. Annu Rev Immunol. 1989; 7:625-55. DOI: 10.1146/annurev.iy.07.040189.003205. View

15.

Khan I . Comorbidity: the major challenge for survival and quality of life in end-stage renal disease. Nephrol Dial Transplant. 1998; 13 Suppl 1:76-9. DOI: 10.1093/ndt/13.suppl_1.76. View

16.

Noori N, Kopple J, Kovesdy C, Feroze U, Sim J, Murali S . Mid-arm muscle circumference and quality of life and survival in maintenance hemodialysis patients. Clin J Am Soc Nephrol. 2010; 5(12):2258-68. PMC: 2994088. DOI: 10.2215/CJN.02080310. View

17.

Noori N, Kalantar-Zadeh K, Kovesdy C, Bross R, Benner D, Kopple J . Association of dietary phosphorus intake and phosphorus to protein ratio with mortality in hemodialysis patients. Clin J Am Soc Nephrol. 2010; 5(4):683-92. PMC: 2849686. DOI: 10.2215/CJN.08601209. View

18.

Nelson E, Hong C, Pesce A, Peterson D, Singh S, POLLAK V . Anthropometric norms for the dialysis population. Am J Kidney Dis. 1990; 16(1):32-7. DOI: 10.1016/s0272-6386(12)80782-7. View

19.

Nuttall M, van der Meulen J, Emberton M . Charlson scores based on ICD-10 administrative data were valid in assessing comorbidity in patients undergoing urological cancer surgery. J Clin Epidemiol. 2006; 59(3):265-73. DOI: 10.1016/j.jclinepi.2005.07.015. View

20.

Xue J, Eggers P, Agodoa L, Foley R, Collins A . Longitudinal study of racial and ethnic differences in developing end-stage renal disease among aged medicare beneficiaries. J Am Soc Nephrol. 2007; 18(4):1299-306. DOI: 10.1681/ASN.2006050524. View