POLYMORBIDITY AS A PREDICTOR OF MORTALITY FOR HEMODIALYSIS PATIENTS
Abstract
THE AIM: to analyze of the polymorbidity structure using the Charlson comorbidity index (CCI), and evaluation of the impact of comorbid status on the life prognosis among hemodialysis (HD) patients. PATIENTS AND METHODS: The observational study with retrospective analysis was performed based on patients medical records data of five dialysis centers in St. Petersburg (N=505; 269 men, 236 women) with analyzes of the basic demographic and anamnestic data, as well as laboratory parameters. In order to determine the polymorbidity structure the CCI has been calculated. The survival analysis was performed based on data of the total mortality in corresponding dialysis centers. RESULTS: The average age of patients was 56,4±13,9 years (from 17 to 85 years). Elderly patients (over 59 years) amounted for 44% of the sample (N=221). The relative risk of death in patients older than 59 years was 2.51 (CI 1,45-4,32, P <0.001). The average value of the CCI was at the high level of comorbidity (>5 points) and was 6,3±3,1 points (from 2 to 15 points). The most common and have an impact on the life prognosis were following comorbidities: peripheral artery disease (N = 277, 55%), relative risk of death 2.33 (CI 1,04-5,22, p <0.05), cerebral atherosclerosis (N = 161, 32%), relative risk of death 2.19 (CI 1,11-4,29, p <0.05), moderate liver damage (N = 159, 31%), relative risk of death 2.11 (CI 1,02-4,51, p <0.05). Increasing of the HD treatment duration in high CCI group (>5 points) was associated with a sharp deterioration in the life prognosis (relative risk of death of 2.85 (CI 1,35-6,04), p <0.05). CONCLUSION: The polymorbidity in CKD, estimated using CCI, determined by a wide range of diseases that have a reciprocal influence on the prognosis for the patient’s life. The prognostically adverse impact of the polymorbidity for patients with complicated comorbid status (CCI>5 points) compounded with increasing of renal replacement therapy duration, which appears to be due to the involvement of specific for HD patients complications of the disease such as mineral and bone disorders, anemia, nutritional disorders, chronic inflammation
About the Authors
K. A. Vishnevskii
City hospital N15
Russian Federation
Russian Federation
A. E. Belyaev
City hospital N15
Russian Federation
Russian Federation
A. N. Mironenko
City hospital N15
Russian Federation
Russian Federation
References
1. Бикбов БТ, Томилина НА. Заместительная терапия больных с хронической почечной недостаточностью в Российской Федерации в 1998-2011 гг. (Отчет по данным Российского регистра заместительной почечной терапии. Часть первая). Нефрология и диализ 2014; 16(1): 11-127
2. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. US Renal Data System, USRDS 2012 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2012
3. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. U.S. Renal Data System, USRDS 2007 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2007
4. Goodkin DA, Young EW, Kurokawa K et al. Mortality among hemodialysis patients in Europe, Japan, and the United States: case-mix effects. Am J Kidney Dis 2004; 44 [Suppl 2]: 16-21
5. Андрусев АМ, Ким ИГ, Бикбов БТ, Томилина НА. Сравнительный анализ эффективности разных видов заместительной почечной терапии в аспекте отдаленных результатов. Нефрология и диализ 2009; 11(1): 21-30
6. Chae JW, Song CS, Kim H et al. Prediction of mortality in patients undergoing maintenance hemodialysis by Charlson Comorbidity Index using ICD-10 database. Nephron Clin Pract 2011; 117(4): 379-384
7. Смирнов АВ, Добронравов ВА, Каюков ИГ. Кардиоренальный континуум: патогенетические основы превентивной нефрологии. Нефрология 2005; 9(3): 7-15
8. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40(5): 373-383
9. Rattanasompattikul M, Feroze U, Molnar MZ et al. Charlson comorbidity score is a strong predictor of mortality in hemodialysis patients. Int Urol Nephrol 2012; 44(6): 1813-1823
10. Harel Z, Wald R, McArthur E et al. Rehospitalizations and Emergency Department Visits after Hospital Discharge in Patients Receiving Maintenance Hemodialysis. J Am Soc Nephrol 2015; 8: [Epub ahead of print]
11. Sridharan S, Berdeprado J, Vilar E et al. A self-report comorbidity questionnaire for haemodialysis patients. BMC Nephrol 2014; 15: 134
12. Бикбов БТ, Кирхман ВВ, Ушакова АИ и др. Предикторы летального исхода у больных на гемодиализе. Нефрология и диализ 2004; 6(2): 154-163
13. Самородская ИВ, Никифорова МА. Терминология и методы оценки влияния коморбидности на прогноз и исходы лечения. Бюлл НЦССХ им. А. Н. Бакулева РАМН 2013; 14(4): 18-26
14. Lin YT, Wu PH, Kuo MC el al. High cost and low survival rate in high comorbidity incident elderly hemodialysis patients. PLoS One 2013; 8(9): e75318
15. Malavade T, Sokwala A, Jassal SV. Dialysis therapies in older patients with end-stage renal disease. Clin Geriatr Med 2013; 29(3): 625-639
16. Longenecker JC, Coresh J, Powe NR el al. Traditional cardiovascular disease risk factors in dialysis patients compared with the general population: the CHOICE Study. J Am Soc Nephrol 2002; 13(7): 1918-1927
17. Смирнов АВ, Добронравов ВА, Румянцев АШ, Мнускина ММ. Факторы риска ИБС у больных, получающих лечение гемодиализом. Нефрология 2002; 7 [Прил 1]: 7- 13
18. Block GA, Klassen PS, Lazarus JM et al. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol 2004; 15(8): 2208-2218
19. Danese MD, Belozeroff V, Smirnakis K, Rothman KJ. Consistent control of mineral and bone disorder in incident hemo dialysis patients. Clin J Am Soc Nephrol 2008; 3(5): 1423-1429
20. Яковенко АА, Яковлев ВД, Асанина ЮЮ, Кучер АГ. Роль хронического воспаления в патогенезе «уремической недостаточности питания» у пациентов с терминальной почечной недостаточностью, получающих лечение хроническим гемодиализом. Нефрология 2009; 13(1): 51-55
21. Ozer ED, Ocal S, Boyacioglu AS. Hepatitis C infection in hemodialysis patients: A review. World J Hepatol 2015; 7(6): 885-895
22. Allen KL, Miskulin D,Yan G et al. Association of nutritional markers with physical and mental health status in prevalent hemodialysis patients from the HEMO study. J Ren Nutr 2002; 12 (3): 160-169
23. Druml W. Malnutrition is bad, but how can one detect malnutrition? Nephrol Dial Transplant 1997; 12(11): 2225-2227
24. Jassal SV, Douglas JF, Stout RW. Prognostic markers in older patients starting renal replacement therapy. Nephrol Dial Transplant 1996; 11(6): 1052-1057
25. Яковенко АА, Кучер АГ, Румянцев АШ. Значение интерлейкина-6 в патогенезе «уремической недостаточности питания» у пациентов с терминальной почечной недостаточностью, получающих лечение хроническим гемодиализом. Нефрология 2010; 14(1): 56-62
26. Смирнов АВ, Нестерова ОБ, Суглобова ЕДидр. Клинико-лабораторная оценка эффективности лечения больных с терминальной стадией почечной недостаточности с использованием хронического гемодиализа и ацидосукцината. Тер арх 2013; 85 (1): 69-75
27. Pozzoni P, Del Vecchio L, Pontoriero G et al. Long-term outcome in hemodialysis: Morbidity and mortality. J Nephrol 2004; 17[Suppl 8]: 87-95
Review
For citations:
Vishnevskii K.A., Belyaev A.E., Mironenko A.N. POLYMORBIDITY AS A PREDICTOR OF MORTALITY FOR HEMODIALYSIS PATIENTS. Nephrology (Saint-Petersburg). 2015;19(4):89-94. (In Russ.)
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