Nephrol Dial Transplant Vol. 19 No. 11 © ERA-EDTA 2004; all rights reserved
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Sir,The points mentioned by Bikbov are appreciated. However, the focus of our study [1] was to compare the outcome predictability of 10 markers of the malnutrition–inflammation complex syndrome (MICS) with each other. Hence, our finding on the significant association of the Charlson co-morbidity index (CCI), which represented a covariate to adjust for, with mortality and hospitalization deserving only a brief mention in that context. The outcome predictability of CCI and its statistical associations with elements of MICS in maintenance dialysis patients are subjects of another ongoing but separate study within our group, which will be reported in the future.
Other groups have also modified the CCI by excluding age as a component [2]. We believe this is a legitimate approach, especially since age has a strong bearing on mortality and can confound the independent value of co-morbid conditions in predicting outcome. Since all dialysis patients have end-stage kidney disease, there is no statistical gain in including this universally positive component. No other changes were implemented in the CCI in our study. We maintained diabetes mellitus in the CCI, since diabetes is divided into two distinct categories (with and without end-organ damage). It is interesting that Bikbov, too, has decided to modify the CCI by changing the weight factor for diabetes. Such modifications, if they lead to improved correlations, are warranted.
With regard to the malnutrition–inflammation score (MIS), only one out of the 10 MIS components is about co-morbid conditions in a limited format, i.e. with four levels of severity for the entire co-morbidity, whereas the modified CCI we used had a fully quantitative score ranging from 0 to 24 [1]. We, too, believe that CCI is a valuable and practical tool with important clinical applications in risk stratification and outcome prediction in maintenance dialysis patients.
Conflict of interest statement. None declared.
Harbor-UCLA Medical Center Torrance California USA Email: kamkal{at}ucla.edu
References
- Kalantar-Zadeh K, Kopple JD, Humphreys MH, Block G. Comparing outcome predictability of markers of malnutrition–inflammation complex syndrome in haemodialysis patients. Nephrol Dial Transplant 2004; 19: 1507–1519
[Abstract/Free Full Text] - Beddhu S, Zeidel ML, Saul M, Seddon P, Samore MH, Stoddard GJ, Bruns FJ. The effects of comorbid conditions on the outcomes of patients undergoing peritoneal dialysis. Am J Med 2002; 112: 696–701[CrossRef][Web of Science][Medline]
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