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

• Autor(a) principal: Pereira,Luísa H.
• Data de Publicação: 2019
• Outros Autores: Mendes,Filipa, Fragoso,André, Silva,Ana P., Neves,Pedro L.
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692019000400005
• topic: Charlson Comorbidity Index; Chronic Kidney Disease; Comorbidities; Elderly; Survival

Introduction: Renal replacement therapy has not always been shown to benefit end-stage renal failure patients who are elderly or have multiple comorbidities. The Charlson Comorbidity Index (CCI) predicts mortality and is frequently used for risk stratification in clinical practice. We evaluated correlation between the Charlson Comorbidity Index and hospital admissions and mortality in chronic kidney disease patients. Methods: This retrospective observational study included 693 patients with an estimated glomerular filtration rate (eGFR)<30 ml/min/1.73m2, followed in pre-dialysis medical appointments (2008-2012). Based on the CCI, the subjects were collapsed into 4 risk groups: <25th percentile (CCI≤5.2; n=172) - G1; 25-50th percentile (CCI: 5.3-6.4; n=162) - G2; 50-75th percentile (CCI: 6.5-7.4; n=177) - G3; and &gt;75th percentile (CCI≥7.5; n=182) - G4. Descriptive statistics, ANOVA, the chi-square and the log-rank tests were used for comparison between groups. The Bonferroni test was used as a post-hoc test. Kaplan-Meier analysis was used to evaluate mortality. Results: Mean age was 70.1 years, 54% women, with an eGFR of 20.2±9.2 ml/min (Modification of Diet in Renal Disease). G1 patients were younger (p<0.001) and showed higher hemoglobin (p<0.001), eGFR (p=0.025), calcium (p=0.033) and albumin (p<0.001). In a multivariate logistic regression model adjusted for gender, age, hemoglobin, phosphorus, parathormone, eGFR, albumin and blood pressure, CCI is a risk factor for hospitalization (ORa=1.362, Cl 95% 1.175-1.580, p<0.0001). Multivariate Cox regression analysis identified higher scores of CCI as an independent risk factor for cardiovascular mortality (HRa=1.24, Cl 95% 1.053-1.467, p=0.010). Survival at 85 months was progressively shorter with higher CCI (G1=86.7%, G2=65.9%, G3=59.35 % and G4=30.4%, log-rank=34.465, p=0.0001). Conclusion: The Charlson Comorbidity Index was shown to be a strong predictor of mortality and hospitalizations in patients with stage IV chronic kidney disease. It might be a valuable tool in dialysis decision-making for patients with advanced chronic kidney disease and severe comorbidity burden.