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Progression in comorbidity before hemodialysis initiation is a valuable predictor of survival in incident patients

Yee-Yung Ng1, Yen-Ni Hung, Shiao-Chi Wu

  • 1Division of Nephrology, Department of Internal Medicine, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan. yyng@vghtpe.gov.tw

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|December 1, 2012
PubMed

Insights

Comorbidity progression before hemodialysis (HD) initiation significantly impacts patient survival. Both the Charlson Comorbidity Index (CCI) score three years prior and its change predict mortality risk in incident HD patients.

Area of Science:

  • Nephrology
  • Public Health
  • Epidemiology

Background:

  • Most studies focus on baseline comorbidity scores and survival in hemodialysis (HD) patients.
  • Few studies examine the impact of comorbidity progression before HD initiation on patient survival.
  • The Romano-Charlson Comorbidity Index (CCI) quantifies disease burden.

Purpose of the Study:

  • To investigate the effect of comorbidity progression score (CCIp) on the survival of incident HD patients.
  • To determine if CCIp, calculated as the change in CCI score before HD initiation, predicts mortality.
  • To analyze risk markers associated with survival in this cohort.

Main Methods:

  • A historical cohort study using Taiwan's National Health Insurance Research Database.
  • Recruited 7391 adult incident HD patients initiating HD in 2006, followed through 2007.
  • Analyzed data using the Romano-Charlson method for CCI scoring, log-rank tests, and Cox regression models.

Main Results:

  • Common comorbidities included diabetes, ulcers, heart failure, chronic pulmonary disease, and cerebrovascular disease.
  • A higher CCI score at three years prior (CCI-3) and an increasing CCI progression score (CCIp) were associated with reduced survival.
  • Each one-point increase in CCI-3 (HR=1.69) and CCIp (HR=1.22) significantly affected survival.

Conclusions:

  • The CCI score three years before HD initiation (CCI-3) is a significant predictor of survival.
  • Comorbidity progression score (CCIp) before HD initiation is a valuable predictor of survival in incident HD patients.
  • These pre-dialysis comorbidity measures aid in risk stratification for hemodialysis patients.
Abstract

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