Charlson comorbidity score is a strong predictor of mortality in hemodialysis patients

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.

Proportion of osteoporotic women remaining at risk for fracture despite adherence to oral bisphosphonates

“…Unfortunately, this clinical patient care database did not have bone turnover marker data for analysis in this adherent population. Some authors have suggested that a persistent osteoporotic T-score indicates patients at higher fracture risk, who might not be candidates for drug holidays [23]. Similarly some authors have proposed considering a BMD target (such as achieving a non-osteoporotic T-score) as a hypothetical goal of treatment [9], based on the finding that persistent BMD Tscores less than -2.5 after treatment with alendronate indicated a higher risk of subsequent fracture in the FLEX trial [14].…”

“…The Charlson Comorbidity Index is generated from ICD9 codes to categorize burden of comorbidities. A higher score on the Charlson Comorbidity index indicates greater number or degree of comorbidities and is a predictor for mortality or for complications in a variety of disease states [22,23]. In addition codes for other major disease groups and selected conditions that may affect bone metabolism or risk of falls were also collected.…”

Treatment frequency and mortality among incident hemodialysis patients in the United States comparing incremental with standard and more frequent dialysis

“…37,38 The CCI was calculated using Quan's Enhanced ICD-9-CM 39 and then categorized into 5 groups; 2 (renal disease only), 3 to 4, 5, 6, and 7 or more. 40 Patients who had diabetic nephropathy as the primary kidney disease were considered to have diabetes with chronic complications.…”

Serum Levels of Intact Parathyroid Hormone, Calcium, and Phosphorus and Risk of Mortality in Hemodialysis Patients

“…Covariates in all models consisted of age, sex, HD vintage, BMI, serum albumin level, and CCI. We used CCI (except renal disease), as it includes all comorbidities and has been validated in several studies as a good predictor of mortality in HD patients (14,15).…”