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

BMC Nephrology

Research Article

Simon D. S. Fraser¹  Paul J. Roderick¹  Christopher McIntyre²  Maarten W. Taal²  Adam Shardlow²  Carl R. May³  Richard J. Fluck⁴  Natasha McIntyre⁴ 

[1] Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, South Academic Block, Southampton General Hospital, Tremona Road, SO16 6YD, Southampton, Hampshire, UK;Division of Medical Sciences and Graduate-Entry Medicine, University of Nottingham, Derby, UK;Faculty of Health Sciences, University of Southampton, Southampton, UK;The Department of Renal Medicine, Royal Derby Hospital NHS Foundation Trust, Derby, Derbyshire, UK;

关键词: Chronic kidney disease;    Comorbidity;    Multimorbidity;    Polypharmacy;    Mortality;   

DOI  :  10.1186/s12882-015-0189-z

 received in 2015-07-03, accepted in 2015-11-19,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundMultimorbidity 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.MethodsA 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.ResultsOne thousand seven hundred forty-one people were recruited, mean age 72.9 +/−9 years. Mean baseline eGFR was 52 ml/min/1.73 m2. 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).ConclusionsIsolated 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.

【 授权许可】

CC BY   
© Fraser et al. 2015