Background/Aims: Many patients with end-stage renal disease have additional comorbidities that are important to clinical study and impact the patient’s outcome. The Charlson Comorbidity Index (CCI) is a popular tool and a strong predictor of outcome in end-stage renal disease patients. We obtained comorbidity data from the hospital discharge database using the International Classification of Disease, 10th revision (ICD-10) and analyzed the mortality rate in incident patients undergoing maintenance hemodialysis (HD). Methods: We evaluated the medical records of a total of 456 patients on HD (58 ± 14 years of age, 56% males). We calculated CCI scores at the start of HD with information from the hospital discharge summary according to the ICD-10 code. We then analyzed patient mortality according to these CCI scores. Results: The percentages of patients that had diabetes with end-organ damage (51.1%), congestive heart failure (9.9%), coronary artery disease (8.1%) and stroke (6.8%) were identified. CCI scores were 5.09 ± 2.01 (range 2–11). Four comorbidity groups were established by quartile ranking of the CCI scores: low, moderate, high and very high. The mortality rates were: 0.83, 7.70, 14.09 and 18.69 deaths/100 patient-years, respectively (p = 0.001). Compared with the low comorbidity group, the hazard ratios for mortality were 9.22 (95% CI 3.29–25.84) for the moderate group, 16.77 (95% CI 5.97–47.11) for the high group, and 22.37 (95% CI 8.08–61.93) for the very high group. Conclusions: The CCI scores using the ICD-10 database information were significant predictors of mortality in incident patients undergoing maintenance HD.

Keywords:
Comorbidity, ICD-10, Mortality, Hemodialysis
1.
Collins AJ, Foley R, Herzog C, Chavers B, Gilbertson D, Ishani A, Kasiske B, Liu J, Mau LW, McBean M, Murray A, St. Peter W, Xue J, Fan Q, Guo H, Li Q, Li S, Li S, Peng Y, Qiu Y, Roberts T, Skeans M, Snyder J, Solid C, Wang C, Weinhandl E, Zaun D, Zhang R, Arko C, Chen SC, Dalleska F, Daniels F, Dunning S, Ebben J, Frazier E, Hanzlik C, Johnson R, Sheets D, Wang X, Forrest B, Constantini E, Everson S, Eggers P, Agodoa L: Excerpts from the United States Renal Data System 2007 annual data report. Am J Kidney Dis 2008;51:S1–S320.
2.
ESRD Registry Committee: Current renal replacement therapy in Korea; Insan Memorial Dialysis Registry 2008. Kor J Nephrol 2009;28:S493–S518.
3.
Greenfield S, Nelson EC, Zubkoff M, Manning W, Rogers W, Kravitz RL, Keller A, Tarlov AR, Ware JE Jr: Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study. JAMA 1992;267:1624–1630.
4.
Khan IH, Catto GR, Edward N, Fleming LW, Henderson IS, MacLeod AM: Influence of coexisting disease on survival on renal-replacement therapy. Lancet 1993;341:415–418.
5.
Chandna SM, Schulz J, Lawrence C, Greenwood RN, Farrington K: Is there a rationale for rationing chronic dialysis? A hospital-based cohort study of factors affecting survival and morbidity. BMJ 1999;318:217–223.
6.
Extermann M: Measuring comorbidity in older cancer patients. Eur J Cancer 2000;36:453–471.
7.
De Groot V, Beckerman H, Lankhorst GJ, Bouter LM: How to measure comorbidity: a critical review of available methods. J Clin Epidemiol 2003;56:221–229.
8.
Hall SF: A user’s guide to selecting a comorbidity index for clinical research. J Clin Epidemiol 2006;59:849–855.
9.
Beddhu S, Bruns FJ, Saul M, Seddon P, Zeidel ML: A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients. Am J Med 2000;108:609–613.
10.
Van Manen JG, Korevaar JC, Dekker FW, Boeschoten EW, Bossuyt PM, Krediet RT: How to adjust for comorbidity in survival studies in ESRD patients: a comparison of different indices. Am J Kidney Dis 2002;40:82–89.
11.
Hall SF: A user’s guide to selecting a comorbidity index for clinical research. J Clin Epidemiol 2006;59:849–855.
12.
Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA: New ICD-10 version of the Charlson Comorbidity Index predicted in-hospital mortality. J Clin Epidemiol 2004;57:1288–1294.
13.
Ramiarina RA, Ramiarina BL, Almeida RMVR, Pereira WCDA: Comorbidity adjustment index for the International Classification of Diseases, 10th revision. Rev Saúde Pública 2008;42:590–597.
14.
Longenecker JC, Coresh J, Klag MJ, Levey AS, Martin AA, Fink NE, Powe NR: Validation of comorbid conditions on the end-stage renal disease medical evidence report: the CHOICE study. Choices for Healthy Outcomes in Caring for ESRD. J Am Soc Nephrol 2000;11:520–529.
15.
Miskulin DC, Athienites NV, Yan G, Martin AA, Ornt DB, Kusek JW, Meyer KB, Levey AS: Comorbidity assessment using the Index of Coexistent Diseases in a multicenter clinical trial. Kidney Int 2001;60:1498–1510.
16.
Goodkin DA, Bragg-Gresham JL, Koenig KG, Wolfe RA, Akiba T, Andreucci VE, Saito A, Rayner HC, Kurokawa K, Port FK, Held PJ, Young EW: Association of comorbid conditions and mortality in hemodialysis patients in Europe, Japan, and the United States: the Dialysis Outcomes and Practice Patterns Study (DOPPS). J Am Soc Nephrol 2003;14:3270–3277.
17.
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;40:373–383.
18.
Davies SJ, Russell L, Bryan J, Phillips L, Russell GI: Comorbidity, urea kinetics, and appetite in continuous ambulatory peritoneal dialysis patients: their interrelationship and prediction of survival. Am J Kidney Dis 1995;26:353–361.
19.
Vermeulen MJ, Tu JV, Schull MJ: ICD-10 adaptations of the Ontario acute myocardial infarction mortality prediction rules performed as well as the original versions. J Clin Epidemiol 2007;60:971–974.
20.
Henderson T, Shepheard J, Sundararajan V: Quality of diagnosis and procedure coding in ICD-10 administrative data. Med Care 2006;44:1011–1019.
21.
Chaudhry S, Jin L, Meltzer D: Use of a self-report-generated Charlson Comorbidity Index for predicting mortality. Med Care 2005;43:607–615.
22.
Merkina SS, Cavanaugh K, Longeneckern JC, Fink NE, Levey AS, Powe NR: Agreement of self-reported comorbid conditions with medical and physician reports varied by disease among end-stage renal disease patients. J Clin Epidemiol 2007;60:634–642.
23.
Needham DM, Scales DC, Laupacis A, Pronovost PJ: A systematic review of the Charlson Comorbidity Index using Canadian administrative databases: a perspective on risk adjustment in critical care research. J Crit Care 2005;20:12–19.
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2010
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