Comorbidity in chronic kidney disease: a large cross-sectional study of prevalence in Scottish primary care

Abstract

Background: Chronic kidney disease (CKD) is commonly comorbid with hypertension, diabetes and cardiovascular disease (CVD). However, the extent of comorbidity in CKD across a wider range of conditions is not well documented. Aim: To ascertain the prevalence of comorbidity (across 39 physical and mental health comorbidities) in adults aged 25 years and over with CKD in a large nationally representative primary care population. Design and Setting: Cross-sectional analysis of a primary care dataset representing 1,274,374 adults in Scotland. Method: Secondary analysis of general practice electronic medical record data. Comparison was made with the entire population without CKD, standardised for age, sex, and socioeconomic status (SES). Results: A total of 98.2% of adults with CKD had at least one comorbidity (vs. 51.8% in controls). After adjustment for age, sex, and deprivation, people with CKD were more likely to have 1-3 conditions (OR 11.2, 95% CI 10.3-12.2), 4-6 conditions (OR 24.9, 95% CI 22.9-27.0), and ≥7 conditions (OR 38.9, 95% CI 35.6-42.6. Furthermore, all concordant (7 out of 7) and the majority of discordant physical health conditions (17 out of 24) and mental health conditions (6 out of 8) had significantly positive associations with CKD after adjustment. Conclusion: CKD is associated with extreme comorbidity, across a wide range of mental and physical conditions. Routine care for people with CKD should include recognition and management of comorbidities and clinical guidelines should support clinicians to do this.

Health conditions in adults with HIV compared with the general population: A population-based cross-sectional analysis

“… 32 Our methodological approach is similar to that used to study the prevalence of comorbidity in other disease areas and we observe similar associations expected with many conditions supporting the validity of results. 33 , 34 , 35 Our study also has some limitations. Our study is cross-sectional in nature and does not provide information on the temporal relationship between HIV and each health condition.…”

Disease severity and renal outcomes of patients with chronic kidney disease infected with COVID-19

“…Patients in the CKD group were older, with higher prevalence of hypertension, diabetes mellitus and atherosclerosis. This is a predictable finding, as CKD is commonly comorbid with hypertension, diabetes, and cardiovascular disease and associated with several comorbidities [ 31 ].…”

Cost of End-of-Life Inpatient Encounters in Patients with Chronic Kidney Disease in the United States: A Report from the DISCOVER CKD Retrospective Cohort

“…The high costs reported previously and in this study are likely driven by multiple factors, including a requirement for intensive medical resources across multiple specialities (e.g., nursing, nephrology, cardiology and geriatric medicine) at the end of life, increased number of bed-days and costs of treating complications such as infections and other high-risk complications. In addition, factors such as comorbidity burden [ 5 , 6 , 8 , 9 ] and complications, which are associated with CKD progression and increase the likelihood of premature death [ 29 – 31 ], may contribute to these findings.…”

“…Worldwide, the number of individuals with kidney diseases, including CKD (843.6 million), renal replacement therapy (3.9 million) and acute kidney injury (13.3 million) is estimated to exceed 850 million [ 2 ]. CKD affects approximately 40% of adults aged ≥ 60 years [ 3 , 4 ], and over 80% of patients with CKD have at least 1 comorbidity [ 5 , 6 ]. CKD was the 12th leading cause of death globally in 2017, an increase compared with past decades [ 1 ].…”