The Charlson Comorbidity Index – its impact on hospitalization and mortality in chronic renal disease

Abstract

Nowadays, as people age and live longer, they are more likely to develop several comorbid conditions, including chronic kidney disease (CKD) 1,2,3. About 60% of deaths worldwide are related to chronic diseases and this number is expected to rise by 15% by 2020 4. Plus, CKD is the 15 th and 20 th cause of years lived with disability 5 and disability-adjusted life years 6. Khan defined comorbidity in kidney failure patients as a significant concurrent or past disease in addition to CKD, which involved organs other than the kidneys but which may also be responsible for the renal failure 2. Risk factors predicting either increased morbidity or mortality among dialysis patients have been well described by earlier research, but are poorly defined in the pre-dialysis population 7. Population ageing has conditioned a progressive increase of very old, dependent and frail patients on dialysis 8. These patients present multiple comorbidities that worsen prognosis and have a negative impact on their quality of life, since it had been shown that comorbidities tend to worsen after dialysis initiation, as does patients' functional status. Estimated life expectancy for these patients, even with renal replacement therapy (RRT), has been quoted to be as low as 8 months 1,9,10. According to the Portuguese Society of Nephrology Registry, in Portugal, 60.2% of incident dialysis patients in 2018 were over 65 years and the mean age of prevalent patients was 67.2 years 11. Age per se is a strong predictor of mortality and the mortality rate is considerably higher for elderly patients on dialysis than those who are not 10. Additionally, for elderly end stage renal disease (ESRD) patients, prompt RRT is costly and does not necessarily extend survival 12. These older patients who are initiated on dialysis require more medical interventions (including dialysis) and are more commonly hospitalized than those treated conservatively 13. Given the rapid growth of elderly populations, it is necessary to adopt practical and useful tools to make mortality prediction easier. Assessment of the overall comorbidities may be helpful to identify those patients whose condition will probably evolve poorly.

Health Related Quality of Life: Chronic Kidney Disease Dengan Hemodialisa Menggunakan Instrumen Eq-5d-5l Di Pekanbaru

“…Meskipun pasien dapat hidup lebih lama dengan HD, namun kualitas hidup pasien akan menurun. Beberapa komorbid yang dijumpai seperti hipertensi, diabetes melitus, dan hiperlidemia (31) .…”