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Charlson comorbidity score is a strong predictor of mortality in hemodialysis patients
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
Affiliation:1. Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, C1-Annex, Torrance, CA, 90502, USA
2. Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
3. Institute of Pathophysiology, Semmelweis University, Budapest, Hungary
4. David Geffen School of Medicine at UCLA and the UCLA School of Public Health, Los Angeles, CA, USA
5. Division of Nephrology, University of Virginia, Charlottesville, VA, USA
6. Division of Nephrology, Salem VA Medical Center, Salem, VA, USA
7. DaVita, Inc., Denver, CO, USA
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?C2), 3rd (mCCI?=?3), and 4th (mCCI: 4?C9) quartiles compared to 1st (mCCI?=?0) quartiles showed death hazard ratios (95% confidence intervals) of 1.43 (0.92?C2.23), 1.70 (1.06?C2.72), and 2.33 (1.43?C3.78), 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?C1.27).

Conclusions

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