Using the modified Charlson comorbidity index to predict the risk of death in elderly and senile patients with chronic kidney disease

The Charlson comorbidity index was calculated in patients with the serum creatinine level of higher than 265 μmol/L, renal replacement therapy, and kidney transplantation. Therefore only chronic kidney disease (CKD) stages 4-5 were analyzed in elderly and senile patients. This study aimed to investigate the Charlson comorbidity index when included as a "renal" parameter of CKD with an estimated glomerular filtration rate <60 ml/min/1.73 m2 to predict the risk of death in patients with chronic kidney disease of elderly and senile age. Materials and methods. 472 patients (241 women and 231 men, mean age 69.6±7.3 years) with stable cardiovascular pathology of elderly and senile age were examined. CKD was diagnosed according to the National Recommendations «Chronic Kidney Disease: Basic Principles of Screening, Diagnostics, Prevention, and Treatment Approaches» (Scientific Society of Nephrologists of Russia, 2012). The comorbidity of patients was assessed using the Charlson comorbidity index, including corrected for age. CKD with an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 was additionally included in the parameter «moderate, severe kidney disease» when we calculated the Charlson comorbidity index. The follow-up period was 12 months; the primary endpoint was total mortality. Results. CKD was diagnosed in 302 (63.9%) out of 472 elderly and senile patients. CKD with eGFR less than 60 ml/min/1.73 m2 was observed in 277 (91.7%) of 302 patients with CKD. An increase in the CKD-modified Charlson comorbidity index of more than 6 points was associated with the risk of annual mortality in elderly and senile patients with stable cardiovascular diseases (RR 4.7; 95% CI 1.4-15.2; p=0.01 versus OR 1.6; 95% CI 1.08-3.35; p=0.02 with original comorbidity index). Conclusions. Modified Charlson comorbidity index expands the possibility for assessing comorbidity and makes the prognosis for annual mortality in elderly and senile patients with CKD more accurate.

индекс коморбидности Чарлсон, коморбидность, прогноз, хроническая болезнь почек, Charlson comorbidity index, chronic kidney disease, comorbidity, prognosis

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