Reference
Hirst JA, Ordóñez Mena JM, O’Callaghan CA, Ogburn E, Taylor CJ, et al. (2021) Prevalence and factors associated with multimorbidity among primary care patients with decreased renal function. PLOS ONE 16(1): e0245131. https://doi.org/10.1371/journal.pone.0245131
Background
CKD is a very common disease which affects about 12% of the world’s population. With aging, renal function tends to gradually deteriorate, resulting in decreased life expectancy. This is both due to the progression of a pre-existing CKD ahead of dialysis and the increased the risk of cardiovascular events. In addition, during aging, people with CKD can develop and be affected by other diseases. For example, a UK study has shown that about 40% of people with CKD Stage III live with more than two chronic diseases and that the number of concurrent diseases is associated with reduced survival. It is clear that healthcare focused on the treatment of multi-morbidities represents a huge challenge in the context of aging, as more than 50% of the elderly live with more than one chronic condition. Multimorbidity also increases the likelihood of hospitalization and the length of a hospital stay, both of which result in increased health costs and reduced quality of life. It is therefore important to understand the relationship between various diseases and CKD in this population so that interventions can be targeted to treat people at higher risk.
Methodology
This study assessed the prevalence of various diseases and factors associated with concurrent diseases in a group of people with CKD and/or transient kidney function reduction. The authors selected 861 people > 60 years old, with reduced kidney function, of which 584 (65.8%) were affected by CKD and 277 (32.2%) did not have CKD. Participants were asked for their medical history and underwent clinical assessment, including blood and urine tests.
Multimorbidity was defined as the presence of >2 chronic conditions, including CKD. Prevalence of each condition, co-existing condition, and multimorbidity were described. Statistical analysis was used to identify predictors of multimorbidity
Results
The results of the study showed that, after CKD, the most common disease was hypertension (59.3%), followed by obesity (30.8%), ischemic heart disease (16.8%) and diabetes (15.4%). The association of two diseases at the same time was found to be prevalent (27%) and the most frequent combination was hypertension and obesity (29%). The authors also reported that the combination of three conditions was quite frequent (21%). The incidence of multimorbidity was 73.9% in all participants and even more frequent in patients with CKD (86.6%). The predictive factors of multimorbidity were: 1) an increase in age, 2) obesity and 3) reduced renal function.
Limitations
The main limitations of the study are:
- the population assessed was composed of people in the UK and, therefore, is not representative of the world population with respect to environmental and genetic differences;
- patients with cancer were excluded.
What’s new?
This study is the first to provide an accurate estimate of the prevalence of multimorbidity in an elderly population affected by or at risk of developing CKD. In particular, the frequency of different diseases and their combinations were analyzed in order to describe the multiple conditions of CKD patients.
Future perspective
These findings suggest the need for a patient-centered approach to treatment and care, especially in the CKD population. The high percentage of patients with hypertension confirms the importance of regular blood pressure monitoring to guide treatment and reduce cardiovascular risk. Similarly, the high frequency of obesity, especially when associated with hypertension in CKD, requires close monitoring and the initiation of appropriate dietary measures.
Edited by: Guido Merlotti, Andrea Colombatto e Vincenzo Cantaluppi
