اندکس کوموربیدیتی چارلسون به‌عنوان فاکتور پیش‌گویی‌کننده قوی مرگ و میر در بیماران همودیالیز مزمن

Background and Objective: Mortality of hemodialysis patients is still high, which can be estimated using the Charlson Comorbidity Index (CCI) and serum albumin. Materials and Methods: This prospective cohort study was conducted on adult chronic hemodialysis patients (n=532) from 9 hemodialysis (HD) facilities in September 2012. The obtained data included demographic factors and laboratory data, which consisted of serum albumin and patients’ comorbidities at the beginning of study, as well as the causes of mortality, hospitalization, and termination of hemodialysis in a 28-month follow-up period. Furthermore, one- and two-year survival of patients was evaluated by CCI and the age of patients was estimated by serum albumin≥ 3.5 g/dL and serum albumin< 3.5 g/dL. Results: The mean age of patients was 56±15.4 years. The participants consisted of 57% men, 41% diabetes, and 43% ischemic heart disease. The mean of dialysis vintage was 44.6±49.1 months. The mean values were 10.6±1.50 g/dl, 3.90±0.35 g/dl, and 1.31±0.21 for serum hemoglobin, serum albumin, and dialysis treatment adequacy (Kt/V; i.e., K=Clearance Dialyzer, T=Time, V=Volume of Distribution of Urea), respectively. A total of 161 (30%) patients passed away (17 per 100 patient a year), and the most common causes of mortality were cardiovascular diseases (42%) and infections (25%). In Cox proportional hazard model, hazard ratio (HR) of death was 1.03 year (95% CI: 1.01-1.05; P=0.007), for serum albumin (g/dL) was 0.21 (95% CI: 0.11-0.40; P<0.001), and for CCI was 1.75 (95% CI: 1.59-1.94; P<0.001). One-year survival probability for patients in the group A (serum albumin≥ 3.5 g/dL) with CCI scores 2-3, 4-5, 6-7, and ≥ 8 were 96%, 92%, 81%, and 64%, respectively. However, these numbers for patients in group B (serum albumin< 3.5 g/dL) were 86%, 75%, 60%, and 42%, respectively. Two-year survival probability for patients in group A with CCI scores 2-3, 4-5, 6-7, and ≥ 8 were 94%, 89%, 73%, and 36%, respectively. Furthermore, the obtained results for patients in group B were 86%, 45%, 39% and 22%, respectively. Conclusion: Charlson Comorbidity Index along with serum albumin and age are appropriate variables to predict one- and two-year survival of HD patients. Therefore, there is a need to take appropriate measures for high risk patients to improve their health status