A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients

Beddhu, Srinivasan; Bruns, Frank; Saul, Melissa; Seddon, Patricia; Zeidel, Mark L.

doi:10.1016/s0002-9343(00)00371-5

Cited by 406 publications

(308 citation statements)

References 14 publications

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“…The medical chart of each MHD patient was thoroughly reviewed by a collaborating physician, and data pertaining to underlying kidney disease and other comorbid conditions were extracted. A modified version of the Charlson comorbidity index was used to assess the severity of comorbidities (25,26).…”

Section: Patient Populationmentioning

confidence: 99%

Association of Dietary Phosphorus Intake and Phosphorus to Protein Ratio with Mortality in Hemodialysis Patients

Noori¹,

Kalantar-Zadeh²,

Kövesdy³

et al. 2010

Clinical Journal of the American Society of Nephrology

195

127

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Background and objectives: Epidemiologic studies show an association between higher predialysis serum phosphorus and increased death risk in maintenance hemodialysis (MHD) patients. The hypothesis that higher dietary phosphorus intake and higher phosphorus content per gram of dietary protein intake are each associated with increased mortality in MHD patients was examined.Design, setting, participants, & measurements: Food frequency questionnaires were used to conduct a cohort study to examine the survival predictability of dietary phosphorus and the ratio of phosphorus to protein intake. At the start of the cohort, Cox proportional hazard regression was used in 224 MHD patients, who were followed for up to 5 years (2001 to 2006).Results: Both higher dietary phosphorus intake and a higher dietary phosphorus to protein ratio were associated with significantly increased death hazard ratios (HR) in the unadjusted models and after incremental adjustments for case-mix, diet, serum phosphorus, malnutrition-inflammation complex syndrome, and inflammatory markers. The HR of the highest (compared with lowest) dietary phosphorus intake tertile in the fully adjusted model was 2.37. Across categories of dietary phosphorus to protein ratios of <12, 12 to <14, 14 to <16, and >16 mg/g, death HRs were 1.13, 1.00 (reference value), 1.80, and 1.99, respectively. Cubic spline models of the survival analyses showed similar incremental associations.Conclusions: Higher dietary phosphorus intake and higher dietary phosphorus to protein ratios are each associated with increased death risk in MHD patients, even after adjustments for serum phosphorus, phosphate binders and their types, and dietary protein, energy, and potassium intakes.

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Section: Patient Populationmentioning

confidence: 99%

Association of Dietary Phosphorus Intake and Phosphorus to Protein Ratio with Mortality in Hemodialysis Patients

Noori¹,

Kalantar-Zadeh²,

Kövesdy³

et al. 2010

Clinical Journal of the American Society of Nephrology

195

127

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“…), and data pertaining to underlying kidney disease, cardiovascular history, and other comorbid conditions were extracted. A modified version of the Charlson comorbidity index, i.e., without the age and kidney disease components, was used to assess the severity of comorbidity (22,23).…”

Section: Patientsmentioning

confidence: 99%

A Low, Rather than a High, Total Plasma Homocysteine Is an Indicator of Poor Outcome in Hemodialysis Patients

Kalantar-Zadeh

Block

Humphreys

et al. 2004

Journal of the American Society of Nephrology

153

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Abstract. An increased level of total plasma homocysteine (tHcy) is a risk factor for poor cardiovascular outcome in the general population. However, a decreased, rather than an increased, tHcy concentration may predict poor outcome in maintenance hemodialysis (MHD) patients, a phenomenon referred to as reverse epidemiology. Associations were examined between tHcy level and markers of malnutrition-inflammation complex syndrome and 12-mo prospective hospitalization and mortality in 367 MHD patients, aged 54.5 Ϯ 14.7 (mean Ϯ SD) years, who included 199 men and 55% individuals with diabetes. tHcy was 24.4 Ϯ 11.8 mol/L, and 94% of the patients had hyperhomocysteinemia (tHcy Ͼ13.5 mol/L). tHcy had weak to moderate but statistically significant bivariate and multivariate correlations with some laboratory markers of nutrition (serum albumin, prealbumin, creatinine, and urea nitrogen) but no significant correlation with serum C-reactive protein or two proinflammatory cytokines (IL-6 and TNF-␣).During 12 mo of follow-up, 191 MHD patients were hospitalized, 37 died, nine underwent renal transplantation, and 38 transferred out. Hospitalization rates were significantly higher in patients with lower tHcy levels. Mortality rate in the lowest tHcy quartile (17.4%) was significantly higher compared with other three quartiles (6.5 to 9.8%; Kaplan-Meier P ϭ 0.04). Relative risk of death for the lowest tHcy quartile, even after adjustment for case-mix and serum albumin, was 2.27 (95% confidence interval, 1.14 to 4.53; P ϭ 0.02). Hence, tHcy may be a more exclusive nutritional marker in MHD patients with no association with inflammatory measures. Despite a very high prevalence of hyperhomocysteinemia in MHD patients, lower values of tHcy are paradoxically associated with increased hospitalization and mortality. The lowest tHcy quartile confers a twofold increase in risk of death independent of hypoalbuminemia. The nutritional feature of tHcy in MHD patients may explain its reverse association with outcome.In the general population, an increased level of total plasma homocysteine (tHcy) is a risk factor for increased cardiovascular events and mortality (1-4). In maintenance hemodialysis (MHD) outpatients, however, the association between tHcy and clinical outcome is inconsistent and even paradoxical. Some studies have shown a poor outcome in MHD patients with hyperhomocysteinemia (5-9). However, a few recent studies have suggested that a decreased, not an increased, tHcy concentration is related to a higher prevalence of cardiovascular disease and poor outcome in these individuals (10 -12). This seems to be due to the empirical association between a low tHcy and protein-energy malnutrition, which is per se a known risk factor for poor clinical outcome in dialysis patients (11,13,14). This recently described paradoxical association between tHcy and clinical outcome in dialysis patients has now been referred to as a possible component of the reversal of the cardiovascular risks (15-17). It is believed that both inflammation and protei...

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“…According to the United States Renal Data System (USRDS) registry, infection is the second leading cause of death in patients with ESRD (the first is cardiovascular disease), and septicemia accounts for more than 75% of these infectious deaths 29 . Indeed, among ESRD patients undergoing dialysis, the total death rate is 176/ 1000 patient-years, and septicemia and pulmonary infections combined account for close to 26/1000 patient-years 1 . Annual death rates due to pneumonia and sepsis are markedly higher in dialysis patients compared with the general population; in the 65-to 74-year-old category, the magnitude of difference is on the order of 10-and 100-fold, respectively 30,31 .…”

Section: Enterococcus Faecium Staphylococcus Auricularimentioning

confidence: 99%

“…In the predialysis era, 60% of patients with chronic renal failure requiring hospitalization were infected and 39% died from infectious causes. It was assumed that the debility caused by the uremic state increased the risk of infection, and the reversal of uremia would reduce the risk of infection 1 . Unfortunately, the prescription of chronic hemodialysis to reduce the uremic state did not reduce the problem of infection; it only changed the paradigm.…”

mentioning

confidence: 99%

Prevelance of Bacteria and Candida Oral Colonization Infections Among Dialyzed Patients

Alhussaini¹

2016

Biosci., Biotech. Res. Asia

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The prospective study aimed to investigate the incidence of bacteria and Candida infections among dialyzed patients admitted to Saudi Arabian Medical Center (Riyadh City, KSA). A total of 55 of microbial isolates were recovered from 56 different cases by taken oral swab from dialyzed patients. Positive clinical specimens were cultured and identified using standard aerobic microbiological techniques. The conventional Candida identification was used for the identification of the isolated strains. Antimicrobial susceptibility testing of the bacteria and Candida isolates was determined. The results of this study revealed that 33 (60%) of isolates were Gram negative and Gram positive bacteria representing Enterobacter cloacae was the most predominant organisms (21.21%). Out of the 56 studied cases, 22 (40%) were positive for 4 species of the genus Candida isolates. Antimicrobial susceptibility results showed that amikacin, gentamicin, ofloxacin, pfloxacin ciprofloxacin, and imipenem were the more antimicrobial agents effective against the Gram negative isolates. While Gram positive bacterial isolates were sensitive to all antimicrobial agents except gentamicin, clindamycin and metronidazol. Antifungal sensitivity of Candida isolates revealed that C.albicans and C.tropicalis were found to be highly susceptible to azoles whereas isolates of Candida species exhibited decreased susceptibility to amphotericin B.

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A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients

Cited by 406 publications

References 14 publications

Association of Dietary Phosphorus Intake and Phosphorus to Protein Ratio with Mortality in Hemodialysis Patients

Association of Dietary Phosphorus Intake and Phosphorus to Protein Ratio with Mortality in Hemodialysis Patients

A Low, Rather than a High, Total Plasma Homocysteine Is an Indicator of Poor Outcome in Hemodialysis Patients

Prevelance of Bacteria and Candida Oral Colonization Infections Among Dialyzed Patients

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