Introduction:
Comorbidity is predictor of adverse dialysis outcomes and shows a tendency to worsen. It is unclear which factors contribute the most.
Methods:
We assessed the initial Charlson Comorbidity Index (CCI) and its change over two years in an unselected group of 77 stable hemodialysis (HD) patients from a single dialysis center.
Results:
In 77 patients aged 54 ± 13 years, of which 67% were men, with a median HD vintage of 32 months (Q1-Q3: 26–88), the initial CCI was 4 points (2–6). Two years later, CCI was 5 points (4–8.5), and the greatest contribution to the baseline CCI came from peripheral vascular disease (28% of patients had it), heart failure (26.7%), diabetes mellitus (10.7%), myocardial infarction, peptic ulcers (9.3%) and stroke (8%). Multiple regression analysis showed that higher baseline comorbidity was directly related to age (+0.56 ± 0.13 per 5-year increase) and the presence of diabetes mellitus and systemic diseases, and inversely related to HD duration. After two years, there was a one (0-2) point increase in CCI due mainly to peripheral vascular diseases (patients proportion with disease increased by 30.7%), liver damage (+26.7%), cancer (+24%), heart failure (+12%). In multiple regression analysis, the greater CCI increase was directly related to age (+0.46 ± 0.16 per five years; p=0.005), interdialytic weight gain (>5%, +0.41±0.20; p=0.044), phosphatemia >1.95 mmol/L (+0.66 ± 0.26; p=0.014), and revealed sarcopenia (+0.53 ± 0.26; p=0.036), but not to protein energy wasting grade. Regression models were adjusted for achievement of anemia correction (target Hb 10.0-12.0 g/dl), calcemia (2.15-2.5 mmol/l), spKt/V (>1.4), and gender.
Conclusions:
Patients on the standard HD regimen are characterized by high comorbidity. Its progression is associated with modifiable factors such as water balance, phosphatemia, and sarcopenia. Correction of these factors presumably the most important for preventing comorbidity progression.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.