Prevalence and factors associated with multimorbidity among primary care patients with decreased renal function

Abstract

Objectives To establish the prevalence of multimorbidity in people with chronic kidney disease (CKD) stages 1–5 and transiently impaired renal function and identify factors associated with multimorbidity. Design and setting Prospective cohort study in UK primary care. Participants 861 participants aged 60 and older with decreased renal function of whom, 584 (65.8%) had CKD and 277 (32.2%) did not have CKD. Interventions Participants underwent medical history and clinical assessment, and blood and urine sampling. Primary and secondary outcome measures Multimorbidity was defined as presence of ≥2 chronic conditions including CKD. Prevalence of each condition, co-existing conditions and multimorbidity were described and logistic regression was used to identify predictors of multimorbidity. Results The mean (±SD) age of participants was 74±7 years, 54% were women and 98% were white. After CKD, the next most prevalent condition was hypertension (n = 511, 59.3%), followed by obesity (n = 265, 30.8%) ischemic heart disease (n = 145, 16.8%) and diabetes (n = 133, 15.4%). Having two co-existing conditions was most common (27%), the most common combination of which was hypertension and obesity (29%). One or three conditions was the next most prevalent combination (20% and 21% respectively). The prevalence of multimorbidity was 73.9% (95%CI 70.9–76.8) in all participants and 86.6% (95%CI 83.9–89.3) in those with any-stage CKD. Logistic regression found a significant association between increasing age (OR 1.07, 95%CI 1.04–0.10), increasing BMI (OR 1.15, 95%CI 1.10–1.20) and decreasing eGFR (OR 0.99, 95%CI 0.98–1.00) with multimorbidity. Conclusions This analysis is the first to provide an accurate estimate of the prevalence of multimorbidity in a screened older primary care population living with or at risk of CKD across all stages. Hypertension and obesity were the most common combination of conditions other than CKD that people were living with, suggesting that there may be multiple reasons for closely monitoring health status in individuals with CKD.

The Dopamine System: Insights between Kidney and Brain

“…Chronic kidney disease (CKD) is one of the most common diseases in adult age, and it is typical of older adults [1][2][3][4][5][6][7]. Recent data suggest that almost half of the elders have CKD.…”

AcceSS and Equity in Transplantation (ASSET) New Zealand: Protocol for population-wide data linkage platform to investigate equity in access to kidney failure health services in New Zealand

“…Kidney failure rarely occurs without the presence of other chronic diseases. Diabetes, hypertension and cardiovascular disease are associated with developing CKD [ 29 ].…”

The interplay between kidney function and multimorbidity: A scoping review

“…We identified five studies that examined the association between kidney function and multimorbidity cross-sectionally [27][28][29][30][31] . Four studies were conducted among CKD patient cohorts in Europe (k = 2) and Asia (k = 2), while one was based on ambulatory data from a statutory health insurance company in Germany.…”

“…Three studies looked at the association between eGFR (continuous) and multimorbidity. A study from the UK found that in a cohort of patients with impaired renal function (CKD stages 1-5), there was an inverse association between eGFR at study entry and the odds of multimorbidity, defined as the co-occurrence of two or more diseases 28 indicates that this condition did not cluster with CKD; Empty cell indicates that the disease was not considered in this study. SPPB: short physical performance battery (higher score indicates better physical performance); COPD: chronic obstructive pulmonary disease.…”