Comorbidity burden at dialysis initiation and mortality: A cohort study

Canadian Journal of Kidney Health and Disease
Alwyn T GomezKarthik K Tennankore

Abstract

A high level of comorbidity at dialysis initiation is associated with an increased risk of death. However, contemporary assessments of the validity and prognostic value of comorbidity indices are lacking. To assess the validity of two comorbidity indices and to determine if a high degree of comorbidity is associated with mortality among dialysis patients. Cohort study. QEII Health Sciences Centre (Halifax, Nova Scotia, Canada). Incident, chronic dialysis patients between 01 Jan 2006 and 01 Jul 2013. The Charlson Comorbidity Index (CCI) and End-Stage Renal Disease Comorbidity Index (ESRD-CI) were used to classify individual comorbid conditions into an overall score. Comorbidities were classified using patient charts and electronic records. All-cause mortality. Confounders: Patient demographics, dialysis access, cause of ESRD and baseline laboratory data. Regression coefficients were estimated on the CCI and ESRD-CI. Discrimination for death was assessed using Harrell's c-index. Adjusted Cox proportional hazard models were used to calculate relative hazards and 95 % confidence intervals for each category of the CCI and ESRD-CI. The cohort consisted of 771 ESRD patients from 01 Jan 2006 to 01 Jul 2013. Most were male (62 %) and Ca...Continue Reading

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