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Creatinine index: a retrospective cohort study in an urban Australian dialysis context

Shaun Chandler1,2, Helen MacLaughlin1,3, Martin Wolley1,2

  • 1Kidney Health Service Royal Brisbane and Women's Hospital, Brisbane, Australia.

Internal Medicine Journal
|March 6, 2023
PubMed

Insights

The creatinine index (CI) effectively predicts mortality in Australian haemodialysis patients. A lower CI indicates higher mortality and stroke risk, while a higher CI is linked to better survival and transplant likelihood.

Area of Science:

  • Nephrology
  • Clinical Epidemiology

Background:

  • Maintenance haemodialysis is a catabolic state leading to decreased lean body mass (LBM) and protein energy wasting.
  • Lean body mass (LBM) can be estimated using creatinine kinetic modelling, specifically the creatinine index (CI).
  • Previous studies suggest the CI predicts mortality in haemodialysis patients.

Purpose of the Study:

  • To describe the relationship between the creatinine index (CI) and mortality in an Australian haemodialysis cohort.
  • To assess the CI's utility in identifying patients at risk for mortality and other adverse outcomes.

Main Methods:

  • A cohort of 179 Australian haemodialysis patients from 2015 was followed for 5 years.
  • Creatinine index (CI) was calculated for each patient.
  • Patients were stratified into high and low CI groups based on the median value (18.32 mg/kg/day).
  • Primary outcome was all-cause mortality; secondary outcomes included myocardial infarction, stroke, and transplantation.

Main Results:

  • Patients in the low CI group had significantly higher mortality (76.7%) compared to the high CI group (31.5%) (P < 0.001).
  • The relative risk of mortality was 2.43 times higher in the low CI group versus the high CI group.
  • A lower CI was associated with an increased risk of stroke (RR, 5.43), while a higher CI was associated with a greater likelihood of transplantation (RR, 6.4).

Conclusions:

  • The creatinine index (CI) is strongly associated with mortality and stroke risk in Australian haemodialysis patients.
  • The CI serves as a simple and accurate method to identify patients with low LBM who are at increased risk of morbidity and mortality.
  • This study reinforces the CI's clinical utility in risk stratification for haemodialysis patients.
Abstract

Keywords:
creatinine indexhaemodialysis mortalitylean body mass

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