Charlson comorbidity score is a strong predictor of mortality in hemodialysis patients

Manoch Rattanasompattikul, Usama Feroze, Miklos Z. Molnar, Ramanath Dukkipati, Csaba P. Kovesdy, Allen R. Nissenson, Keith C. Norris, Joel D. Kopple, Kamyar Kalantar-Zadeh

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43 Citations (Scopus)


Purpose: The Charlson comorbidity index (CCI) is a commonly used scale for assessing morbidity, but its role in assessing mortality in hemodialysis patients is not clear. Age, a component of CCI, is a strong risk factor for morbidity and mortality in chronic diseases and correlates with comorbidities. We hypothesized that the Charlson comorbidity index without age is a strong predictor of mortality in hemodialysis patients. Methods: A 6-year cohort of 893 hemodialysis patients was examined for an association between a modified CCI (without age and kidney disease) (mCCI) and mortality. Results: Patients were 53 ± 15 years old (mean ± SD), had a median mCCI score of 2, and included 47% women, 31% African Americans and 55% diabetics. After adjusting for case-mix and nutritional and inflammatory markers including C-reactive protein and interleukin-6, 2nd (mCCI: 1-2), 3rd (mCCI = 3), and 4th (mCCI: 4-9) quartiles compared to 1st (mCCI = 0) quartiles showed death hazard ratios (95% confidence intervals) of 1.43 (0.92-2.23), 1.70 (1.06-2.72), and 2.33 (1.43-3.78), respectively. The mCCI-death association was robust in non-African Americans. The CCI-death association linearity was verified in cubic splines. Each 1 unit higher mCCI score was associated with a death hazard ratio of 1.16 (1.07-1.27). Conclusions: CCI independent of age is a robust and linear predictor of mortality in hemodialysis patients, in particular in non-African Americans.

Original languageEnglish
Pages (from-to)1813-1823
Number of pages11
JournalInternational urology and nephrology
Issue number6
Publication statusPublished - Dec 1 2012



  • Charlson Comorbidity Index
  • Chronic Kidney Disease (CKD)
  • Hemodialysis
  • Inflammation
  • Survival

ASJC Scopus subject areas

  • Nephrology
  • Urology

Cite this

Rattanasompattikul, M., Feroze, U., Molnar, M. Z., Dukkipati, R., Kovesdy, C. P., Nissenson, A. R., Norris, K. C., Kopple, J. D., & Kalantar-Zadeh, K. (2012). Charlson comorbidity score is a strong predictor of mortality in hemodialysis patients. International urology and nephrology, 44(6), 1813-1823.