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THE BURDEN AND SURVIVAL IMPLICATIONS OF COMORBIDITYIN PEOPLE WITH CHRONIC KIDNEY DISEASE STAGE 3
Fraser SDS,1 Roderick P,1, May C2, McIntyre N4, McIntyre C4, Fluck R3, Shardlow A4, Taal M4
1Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton
2Faculty of Health Sciences, University of Southampton, Southampton
3Department of Renal Medicine, Royal Derby Hospital, Derby
4Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby
BACKGROUND
Multimorbidity is a growing concern for health and social care systems due to demographic andepidemiological transition. Chronic kidney disease (CKD) is common but the extent and prognostic significance of its comorbidities is not well understood. This study describes the prevalence and survival implications of eleven comorbidities (and the associated medication burden) in a cohort of people with CKD stage 3 in a primary care setting
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 for biochemistry. Self-reported comorbidity and medication burden was described and a Kaplan Meier plot and multivariable Cox proportional hazards models(adjusted for age, sex, smoking, estimated glomerular filtration rate (eGFR), urinary albumin to creatinine ratio (uACR) and number of comorbidities) were used to investigate associations between comorbidity and all-cause mortality.
RESULTS
1741 people were recruited, mean age was 73 +/-9 years. 67% were over 70. Only 78/1741 (4%) had no comorbidities, 453/1741 (26%) had one comorbidity, 508/1741 (29%) had two comorbidities and 702/1741 (40%) had more than two comorbidities. Hypertension was almost ubiquitous (88%). The next commonest were painful condition 30%, anaemia 24%,ischaemic heart disease 23%,diabetes 17% and thyroid disorder 12% respectively). 175/1741 (10%) died after a median of 3.6 years of follow up, most commonly from cardiovascular disease (41%). Greater degree of comorbidity was independently associated with all-cause mortality (hazard ratio 2.74 (95% CI 1.69-4.48, p<0.001) for more than two comorbidities compared to none or one). Greater comorbidity burden was associated with taking higher numbers of medications (175/702 (25%) people with more than 2 comorbidities were taking 10 or more medications vs. 2/531 (0.4%) of those with 0 or 1 comorbidity, p<0.001 for trend).
CONCLUSIONS
Isolated CKD was rare and whilst vascular related comorbid conditions were common there was a diverse range of comorbidities in this cohort of people with moderate CKD recruited in primary care. The extent of multimorbidity was associated with medication burden and poorer survival. Integrated care for people with CKD should recognise this complexity and consider treatment, care burden and impact on patient capacity (including quality of life, function and balancing the overall benefit of interventions).