Chronic kidney disease in the context of multimorbidity patterns: the role of physical performance

BMC Geriatrics

Christian Weingart¹  Sara Lainez Martinez²  Pedro Gil²  Agnieszka Guligowska³  Tomasz Kostka³  Gerhard Wirnsberger⁴  Regina Roller-Wirnsberger⁴  Ellen Freiberger⁵  Axel C. Carlsson⁶  Johan Ärnlöv⁷  Rafael Moreno-Gonzalez⁸  Francesc Formiga⁸  Fabrizia Lattanzio⁹  Andrea Corsonello^1,10  Paolo Fabbietti^1,11  Ilan Yehoshua^1,12  Francesco Mattace-Raso^1,13  Lisanne Tap^1,13  Itshak Melzer^1,14 

[1] Department of General Internal Medicine and Geriatrics, Institute for Biomedicine of Aging, Krankenhaus Barmherzige Brüder, Friedrich-Alexander-Universität Erlangen-Nürnberg, 93049, Regensburg, Germany;Department of Geriatric Medicine, Hospital Clinico San Carlos, Madrid, Spain;Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Lodz, Lodz, Poland;Department of Internal Medicine, Medical University of Graz, Graz, Austria;Department of Internal Medicine-Geriatrics, Institute for Biomedicine of Aging, Krankenhaus Barmherzige Brüder, Friedrich-Alexander Universität Erlangen-Nürnberg, Koberger Strasse 60, 90408, Nuremberg, Germany;Department of Medical Sciences, Uppsala University, Uppsala, Sweden;Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden;Department of Medical Sciences, Uppsala University, Uppsala, Sweden;School of Health and Social Studies, Dalarna University, Falun, Sweden;Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden;Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital – IDIBELL – L’Hospitalet de Llobregat, Barcelona, Spain;Italian National Research Center on Aging (IRCCS INRCA), Ancona, Fermo and Cosenza, Italy;Italian National Research Center on Aging (IRCCS INRCA), Ancona, Fermo and Cosenza, Italy;Laboratory of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Via S. Margherita 5, 60124, Ancona, Italy;Laboratory of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Via S. Margherita 5, 60124, Ancona, Italy;Maccabi Health Organization, Negev District, Israel;Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands;The Recanati School for Community Health Professions at the faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel;

关键词: Chronic kidney disease;    Multimorbidity;    Short physical performance battery;    Older;   

DOI  :  10.1186/s12877-020-01696-4

来源: Springer

【 摘 要 】

BackgroundChronic kidney disease (CKD) is known to be associated with several co-occurring conditions. We aimed at exploring multimorbidity patterns associated with CKD, as well as the impact of physical performance and CKD severity on them in a population of older outpatients.MethodsOur series consisted of 2252 patients enrolled in the Screening of CKD among Older People across Europe multicenter observational study. Hypertension, stroke, transient ischemic attack, cancer, hip fracture, osteoporosis, Parkinson’s disease, asthma, chronic obstructive pulmonary disease, congestive heart failure, angina, myocardial infarction, atrial fibrillation, anemia, CKD (defined as GFR < 60, < 45 or < 30 ml/min/1.73 m2), cognitive impairment, depression, hearing impairment and vision impairment were included in the analyses. Physical performance was assessed by the Short Physical Performance Battery (SPPB) and used as stratification variable. Pairs of co-occurring diseases were analyzed by logistic regression. Patterns of multimorbidity were investigated by hierarchical cluster analysis.ResultsCKD was among the most frequently observed conditions and it was rarely observed without any other co-occurring disease. CKD was significantly associated with hypertension, anemia, heart failure, atrial fibrillation, myocardial infarction and hip fracture. When stratifying by SPPB, CKD was also significantly associated with vision impairment in SPPB = 5–8 group, and hearing impairment in SPPB = 0–4 group. Cluster analysis individuated two main clusters, one including CKD, hypertension and sensory impairments, and the second including all other conditions. Stratifying by SPPB, CKD contribute to a cluster including diabetes, anemia, osteoporosis, hypertension and sensory impairments in the SPPB = 0–4 group. When defining CKD as eGFR< 45 or 30 ml/min/1.73 m2, the strength of the association of CKD with hypertension, sensory impairments, osteoporosis, anemia and CHF increased together with CKD severity in pairs analysis. Severe CKD (eGFR< 30 ml/min/1.73 m2) contributed to a wide cluster including cardiovascular, respiratory and neurologic diseases, as well as osteoporosis, hip fracture and cancer.ConclusionsCKD and its severity may contribute significantly to specific multimorbidity patterns, at least based on the cluster analysis. Physical performance as assessed by SPPB may be associated with not negligible changes in both co-occurring pairs and multimorbidity clusters.Trial registrationThe SCOPE study is registered at clinicaltrials.gov (NCT02691546).

【 授权许可】

CC BY