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

  • Nephrology - Original Paper
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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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Acknowledgments

The study was supported by Dr. Kalantar-Zadeh’s research grants from the National Institute of Diabetes, Digestive and Kidney Disease of the National Institute of Health (R01 DK078106, R21 DK078012, and K23 DK61162), a research grant from DaVita Clinical Research and a philanthropic grant from Mr. Harold Simmons. MZM received grants from the National Developmental Agency (KTIA-OTKA-EU 7KP-HUMAN-MB08-A-81231) from the Research and Technological Innovation Fund, was also supported by Hungarian Kidney Foundation.

Conflict of interest

Dr. Nissenson is an employee of DaVita. Dr. Kalantar-Zadeh is the medical director of DaVita Harbor-UCLA/MFI in Long Beach, CA. Other authors have not declared any conflict of interest.

Author information

Authors and Affiliations

  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

    Manoch Rattanasompattikul, Usama Feroze, Miklos Z. Molnar & Kamyar Kalantar-Zadeh

  2. Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA

    Manoch Rattanasompattikul, Usama Feroze, Ramanath Dukkipati, Joel D. Kopple & Kamyar Kalantar-Zadeh

  3. Institute of Pathophysiology, Semmelweis University, Budapest, Hungary

    Miklos Z. Molnar

  4. David Geffen School of Medicine at UCLA and the UCLA School of Public Health, Los Angeles, CA, USA

    Ramanath Dukkipati, Allen R. Nissenson, Keith C. Norris, Joel D. Kopple & Kamyar Kalantar-Zadeh

  5. Division of Nephrology, University of Virginia, Charlottesville, VA, USA

    Csaba P. Kovesdy

  6. Division of Nephrology, Salem VA Medical Center, Salem, VA, USA

    Csaba P. Kovesdy

  7. DaVita, Inc., Denver, CO, USA

    Allen R. Nissenson

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  1. Manoch Rattanasompattikul
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  2. Usama Feroze
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  9. Kamyar Kalantar-Zadeh
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Correspondence to Kamyar Kalantar-Zadeh.

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Rattanasompattikul, M., Feroze, U., Molnar, M.Z. et al. Charlson comorbidity score is a strong predictor of mortality in hemodialysis patients. Int Urol Nephrol 44, 1813–1823 (2012). https://doi.org/10.1007/s11255-011-0085-9

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  • DOI: https://doi.org/10.1007/s11255-011-0085-9

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