The choice of comorbidity scoring system in Chinese peritoneal dialysis patients
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Several comorbidity scoring systems have been developed and validated, mostly in western hemodialysis patients with a high risk of cardiovascular disease. The performance of comorbidity scoring, however, depends on the patient population. In this study, we determine the optimal comorbidity scoring system for predicting survival of incident Chinese PD patients.
We studied 461 incident PD patients. The performance of Charlson Comorbidity Index (CCI), Hemmelgarn score, and Liu score as the survival predictor was compared.
The mean age was 57.7 ± 13.7 years. The median CCI, Hemmelgarn, and Liu scores were 4 [inter-quartile range (IQR) 2–5], 1 (IQR 0–2), and 4 (IQR 2–5), respectively. Patients were followed for 45.5 ± 33.0 months. All 3 comorbidity scores were predictors of patient survival by univariate analysis. After adjusting for confounding factors, CCI was the best predictor of patient survival among the 3 indices, with each point increase in CCI conferring 31% excess in mortality risk [95% confidence interval (CI) 21–41%, p < 0.001]. In contrast, each point increase in Liu score confers 20% excess in mortality risk (95% CI 13–27%, p < 0.001). Although the Hemmelgarn score is an independent predictor of patient survival, over 70% of patients score 0 or 1 by this system, limiting its role as a prognostic marker.
CCI should be the preferred method for quantifying comorbidity load in incident Chinese PD patients, and it is a good predictor of survival in this group of patients.
KeywordsRenal failure Cardiovascular disease Survival
Compliance with ethical standards
Conflict of interest
This study was supported by the Chinese University of Hong Kong (CUHK) research accounts 6901031. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Dr. CC Szeto receives research grant and consultancy from Baxter Healthcare. The authors declare no other conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee at which the studies were conducted and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Clinical Research Ethics Committee of the Chinese University of Hong Kong (IRB Approval Number CREC-2008.276).
Written informed consent was obtained from all individual participants included in the study.
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