Kan et al developed a new comorbidity index for evaluating older adults requiring dialysis. This can help to identify a patient who may benefit from aggressive management. The authors are from Chi-Mei Medical Center, Chung Hwa University of Medical Technology, and Southern Taiwan University in Taiwan.
Patient selection: age >= 65 years at the start of dialysis
Comorbid conditions:
(1) diabetes mellitus
(2) congestive heart failure (CHF)
(3) coronary artery disease (CAD)
(4) cerebrovascular disease (CVD)
(5) peripheral arterial disease (PAD)
(6) other cardiac conditions (valve disorders, etc)
(7) cardiac dysrhythmias
(8) chronic obstructive pulmonary disease (COPD)
(9) gastrointestinal tract bleeding
(10) liver disease
(11) cancer
|
Parameter |
Finding |
Points |
|---|---|---|
|
diabetes mellitus |
absent |
0 |
|
|
present |
1 |
|
CHF |
absent |
0 |
|
|
present |
3 |
|
coronary artery disease |
absent |
0 |
|
|
present |
1 |
|
cerebrovascular disease |
absent |
0 |
|
|
present |
2 |
|
peripheral arterial disease |
absent |
0 |
|
|
present |
2 |
|
other cardiac conditions |
absent |
0 |
|
|
present |
2 |
|
cardiac dysrhythmias |
absent |
0 |
|
|
present |
2 |
|
COPD |
absent |
0 |
|
|
present |
2 |
|
GI bleeding |
absent |
0 |
|
|
present |
2 |
|
liver disease |
absent |
0 |
|
|
present |
2 |
|
cancer |
absent |
0 |
|
|
present |
2 |
total score =new comorbidity index =
= SUM(points for all 11 parameters)
Interpretation:
• minimum score: 0
• maximum score: 21
• The higher the score the greater the comorbidity.
The index can be used together with age to predict life expectancy.
|
Age |
nCI |
Life Expectancy |
|---|---|---|
|
65 - 69 |
<= 3 |
6.2 |
|
|
4 to 6 |
4.8 |
|
|
7 to 9 |
4.0 |
|
|
>= 10 |
3.4 |
|
70 to 74 |
<= 3 |
5.4 |
|
|
4 to 6 |
4.2 |
|
|
7 to 9 |
3.9 |
|
|
>= 10 |
3.9 |
|
75 to 79 |
<= 3 |
4.9 |
|
|
4 to 6 |
3.9 |
|
|
7 to 9 |
3.3 |
|
|
>= 10 |
3.2 |
|
80 to 84 |
<= 3 |
4.0 |
|
|
4 to 6 |
3.2 |
|
|
7 to 9 |
3.0 |
|
|
>= 10 |
2.5 |
|
>= 85 |
<= 3 |
2.9 |
|
|
4 to 6 |
2.7 |
|
|
7 to 9 |
2.7 |
|
|
>= 10 |
2.3 |
from Figure 3
ICD-10: ,
