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The burden of comorbidity in people with chronic kidney disease stage 3: a cohort study

The burden of comorbidity in people with chronic kidney disease stage 3: a cohort study
The burden of comorbidity in people with chronic kidney disease stage 3: a cohort study
BACKGROUND: Multimorbidity is a growing concern for healthcare systems, with many countries experiencing demographic transition to older population profiles. Chronic kidney disease (CKD) is common but often considered in isolation. The extent and prognostic significance of its comorbidities is not well understood. This study aimed to assess the extent and prognostic significance of 11 comorbidities in people with CKD stage 3.

METHODS:A prospective cohort of 1741 people with CKD stage 3 was recruited from primary care between August 2008 and March 2010. Participants underwent medical history, clinical assessment, blood and urine sampling. Comorbidity was defined by self-reported doctor-diagnosed condition, disease-specific medication or blood results (hemoglobin), and treatment burden as number of ongoing medications. Logistic regression was used to identify associations with greater treatment burden (taking >5 medications) and greater multimorbidity (3 or more comorbidities). Kaplan Meier plots and multivariate Cox proportional hazards models were used to investigate associations between multimorbidity and all-cause mortality.

RESULTS:One thousand seven hundred forty-one people were recruited, mean age 72.9 +/-9 years. Mean baseline eGFR was 52 ml/min/1.73 m(2). Only 78/1741 (4 %) had no comorbidities, 453/1741 (26 %) had one, 508/1741 (29 %) had two and 702/1741 (40 %) had >2. Hypertension was common (88 %), 30 % had 'painful condition', 24 % anemia, 23 %, ischaemic heart disease, 17 % diabetes and 12 % thyroid disorders. Median medication use was 5 medications (interquartile range 3-8) and increased with degree of comorbidity. Greater treatment burden and multimorbidity were independently associated with age, smoking, increasing body mass index and decreasing eGFR. Treatment burden was also independently associated with lower education status. After median 3.6 years follow-up, 175/1741 (10 %) died. Greater multimorbidity was independently associated with mortality (hazard ratio 2.81 (95 % confidence intervals 1.72-4.58), p < 0.001) for 3 or more comorbidities vs 0 or 1).

CONCLUSIONS: Isolated CKD was rare and multimorbidity the norm in this cohort of people with moderate CKD. Increasing multimorbidity was associated with greater medication burden and poorer survival. CKD management should include consideration of comorbidities.
chronic kidney disease, cormorbidity, multimorbidity, polypharmacy, mortality
1471-2369
Fraser, Simon D.S.
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Roderick, Paul J.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
May, Carl R.
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McIntyre, Natasha
8c2ce4ad-5acb-4fa8-bdb2-b90dda68a627
McIntyre, Christopher
915b9a24-040f-46d6-8b21-bc42b3c7cd75
Fluck, Richard J.
fedcd5a4-5459-461f-bef0-3747f4a3757d
Shardlow, Adam
abbfb299-8658-4670-a958-433654655aa6
Taal, Maarten W.
10eeea62-a2fc-43b6-b5af-359e75c501ea
Fraser, Simon D.S.
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Roderick, Paul J.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
May, Carl R.
17697f8d-98f6-40d3-9cc0-022f04009ae4
McIntyre, Natasha
8c2ce4ad-5acb-4fa8-bdb2-b90dda68a627
McIntyre, Christopher
915b9a24-040f-46d6-8b21-bc42b3c7cd75
Fluck, Richard J.
fedcd5a4-5459-461f-bef0-3747f4a3757d
Shardlow, Adam
abbfb299-8658-4670-a958-433654655aa6
Taal, Maarten W.
10eeea62-a2fc-43b6-b5af-359e75c501ea

Fraser, Simon D.S., Roderick, Paul J., May, Carl R., McIntyre, Natasha, McIntyre, Christopher, Fluck, Richard J., Shardlow, Adam and Taal, Maarten W. (2015) The burden of comorbidity in people with chronic kidney disease stage 3: a cohort study. BMC Nephrology, 16, [193]. (doi:10.1186/s12882-015-0189-z). (PMID:26620131)

Record type: Article

Abstract

BACKGROUND: Multimorbidity is a growing concern for healthcare systems, with many countries experiencing demographic transition to older population profiles. Chronic kidney disease (CKD) is common but often considered in isolation. The extent and prognostic significance of its comorbidities is not well understood. This study aimed to assess the extent and prognostic significance of 11 comorbidities in people with CKD stage 3.

METHODS:A prospective cohort of 1741 people with CKD stage 3 was recruited from primary care between August 2008 and March 2010. Participants underwent medical history, clinical assessment, blood and urine sampling. Comorbidity was defined by self-reported doctor-diagnosed condition, disease-specific medication or blood results (hemoglobin), and treatment burden as number of ongoing medications. Logistic regression was used to identify associations with greater treatment burden (taking >5 medications) and greater multimorbidity (3 or more comorbidities). Kaplan Meier plots and multivariate Cox proportional hazards models were used to investigate associations between multimorbidity and all-cause mortality.

RESULTS:One thousand seven hundred forty-one people were recruited, mean age 72.9 +/-9 years. Mean baseline eGFR was 52 ml/min/1.73 m(2). Only 78/1741 (4 %) had no comorbidities, 453/1741 (26 %) had one, 508/1741 (29 %) had two and 702/1741 (40 %) had >2. Hypertension was common (88 %), 30 % had 'painful condition', 24 % anemia, 23 %, ischaemic heart disease, 17 % diabetes and 12 % thyroid disorders. Median medication use was 5 medications (interquartile range 3-8) and increased with degree of comorbidity. Greater treatment burden and multimorbidity were independently associated with age, smoking, increasing body mass index and decreasing eGFR. Treatment burden was also independently associated with lower education status. After median 3.6 years follow-up, 175/1741 (10 %) died. Greater multimorbidity was independently associated with mortality (hazard ratio 2.81 (95 % confidence intervals 1.72-4.58), p < 0.001) for 3 or more comorbidities vs 0 or 1).

CONCLUSIONS: Isolated CKD was rare and multimorbidity the norm in this cohort of people with moderate CKD. Increasing multimorbidity was associated with greater medication burden and poorer survival. CKD management should include consideration of comorbidities.

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Accepted/In Press date: 19 November 2015
e-pub ahead of print date: 1 December 2015
Published date: 1 December 2015
Keywords: chronic kidney disease, cormorbidity, multimorbidity, polypharmacy, mortality
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 387073
URI: http://eprints.soton.ac.uk/id/eprint/387073
ISSN: 1471-2369
PURE UUID: bf3c0e87-d8cc-4375-9f28-20b6dd2e9a5d
ORCID for Simon D.S. Fraser: ORCID iD orcid.org/0000-0002-4172-4406
ORCID for Paul J. Roderick: ORCID iD orcid.org/0000-0001-9475-6850
ORCID for Carl R. May: ORCID iD orcid.org/0000-0002-0451-2690

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Date deposited: 09 Feb 2016 10:05
Last modified: 15 Mar 2024 03:31

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Contributors

Author: Carl R. May ORCID iD
Author: Natasha McIntyre
Author: Christopher McIntyre
Author: Richard J. Fluck
Author: Adam Shardlow
Author: Maarten W. Taal

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