Prevalence and factors associated with multimorbidity among primary care patients with decreased renal function

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Abstract

Objectives

To establish the prevalence of multimorbidity in people with chronic kidney disease (CKD) stages 1–5 and transiently impaired renal function and identify factors associated with multimorbidity.

Design and setting

Prospective cohort study in UK primary care.

Participants

861 participants aged 60 and older with decreased renal function of whom, 584 (65.8%) had CKD and 277 (32.2%) did not have CKD.

Interventions

Participants underwent medical history and clinical assessment, and blood and urine sampling.

Primary and secondary outcome measures

Multimorbidity was defined as presence of ≥2 chronic conditions including CKD. Prevalence of each condition, co-existing conditions and multimorbidity were described and logistic regression was used to identify predictors of multimorbidity.

Results

The mean (±SD) age of participants was 74±7 years, 54% were women and 98% were white. After CKD, the next most prevalent condition was hypertension (n = 511, 59.3%), followed by obesity (n = 265, 30.8%) ischemic heart disease (n = 145, 16.8%) and diabetes (n = 133, 15.4%). Having two co-existing conditions was most common (27%), the most common combination of which was hypertension and obesity (29%). One or three conditions was the next most prevalent combination (20% and 21% respectively). The prevalence of multimorbidity was 73.9% (95%CI 70.9–76.8) in all participants and 86.6% (95%CI 83.9–89.3) in those with any-stage CKD. Logistic regression found a significant association between increasing age (OR 1.07, 95%CI 1.04–0.10), increasing BMI (OR 1.15, 95%CI 1.10–1.20) and decreasing eGFR (OR 0.99, 95%CI 0.98–1.00) with multimorbidity.

Conclusions

This analysis is the first to provide an accurate estimate of the prevalence of multimorbidity in a screened older primary care population living with or at risk of CKD across all stages. Hypertension and obesity were the most common combination of conditions other than CKD that people were living with, suggesting that there may be multiple reasons for closely monitoring health status in individuals with CKD.

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Most cited references 41

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A new equation to estimate glomerular filtration rate.

Andrew Levey, Lesley Stevens, Christopher H Schmid … (2009)

Equations to estimate glomerular filtration rate (GFR) are routinely used to assess kidney function. Current equations have limited precision and systematically underestimate measured GFR at higher values. To develop a new estimating equation for GFR: the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Cross-sectional analysis with separate pooled data sets for equation development and validation and a representative sample of the U.S. population for prevalence estimates. Research studies and clinical populations ("studies") with measured GFR and NHANES (National Health and Nutrition Examination Survey), 1999 to 2006. 8254 participants in 10 studies (equation development data set) and 3896 participants in 16 studies (validation data set). Prevalence estimates were based on 16,032 participants in NHANES. GFR, measured as the clearance of exogenous filtration markers (iothalamate in the development data set; iothalamate and other markers in the validation data set), and linear regression to estimate the logarithm of measured GFR from standardized creatinine levels, sex, race, and age. In the validation data set, the CKD-EPI equation performed better than the Modification of Diet in Renal Disease Study equation, especially at higher GFR (P < 0.001 for all subsequent comparisons), with less bias (median difference between measured and estimated GFR, 2.5 vs. 5.5 mL/min per 1.73 m(2)), improved precision (interquartile range [IQR] of the differences, 16.6 vs. 18.3 mL/min per 1.73 m(2)), and greater accuracy (percentage of estimated GFR within 30% of measured GFR, 84.1% vs. 80.6%). In NHANES, the median estimated GFR was 94.5 mL/min per 1.73 m(2) (IQR, 79.7 to 108.1) vs. 85.0 (IQR, 72.9 to 98.5) mL/min per 1.73 m(2), and the prevalence of chronic kidney disease was 11.5% (95% CI, 10.6% to 12.4%) versus 13.1% (CI, 12.1% to 14.0%). The sample contained a limited number of elderly people and racial and ethnic minorities with measured GFR. The CKD-EPI creatinine equation is more accurate than the Modification of Diet in Renal Disease Study equation and could replace it for routine clinical use. National Institute of Diabetes and Digestive and Kidney Diseases.

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Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.

Karen Barnett, Stewart Mercer, Michael Norbury … (2012)

Long-term disorders are the main challenge facing health-care systems worldwide, but health systems are largely configured for individual diseases rather than multimorbidity. We examined the distribution of multimorbidity, and of comorbidity of physical and mental health disorders, in relation to age and socioeconomic deprivation. In a cross-sectional study we extracted data on 40 morbidities from a database of 1,751,841 people registered with 314 medical practices in Scotland as of March, 2007. We analysed the data according to the number of morbidities, disorder type (physical or mental), sex, age, and socioeconomic status. We defined multimorbidity as the presence of two or more disorders. 42·2% (95% CI 42·1-42·3) of all patients had one or more morbidities, and 23·2% (23·08-23·21) were multimorbid. Although the prevalence of multimorbidity increased substantially with age and was present in most people aged 65 years and older, the absolute number of people with multimorbidity was higher in those younger than 65 years (210,500 vs 194,996). Onset of multimorbidity occurred 10-15 years earlier in people living in the most deprived areas compared with the most affluent, with socioeconomic deprivation particularly associated with multimorbidity that included mental health disorders (prevalence of both physical and mental health disorder 11·0%, 95% CI 10·9-11·2% in most deprived area vs 5·9%, 5·8%-6·0% in least deprived). The presence of a mental health disorder increased as the number of physical morbidities increased (adjusted odds ratio 6·74, 95% CI 6·59-6·90 for five or more disorders vs 1·95, 1·93-1·98 for one disorder), and was much greater in more deprived than in less deprived people (2·28, 2·21-2·32 vs 1·08, 1·05-1·11). Our findings challenge the single-disease framework by which most health care, medical research, and medical education is configured. A complementary strategy is needed, supporting generalist clinicians to provide personalised, comprehensive continuity of care, especially in socioeconomically deprived areas. Scottish Government Chief Scientist Office. Copyright © 2012 Elsevier Ltd. All rights reserved.

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Global Prevalence of Chronic Kidney Disease – A Systematic Review and Meta-Analysis

Nathan Hill, Samuel T Fatoba, Jason L. Oke … (2016)

Chronic kidney disease (CKD) is a global health burden with a high economic cost to health systems and is an independent risk factor for cardiovascular disease (CVD). All stages of CKD are associated with increased risks of cardiovascular morbidity, premature mortality, and/or decreased quality of life. CKD is usually asymptomatic until later stages and accurate prevalence data are lacking. Thus we sought to determine the prevalence of CKD globally, by stage, geographical location, gender and age. A systematic review and meta-analysis of observational studies estimating CKD prevalence in general populations was conducted through literature searches in 8 databases. We assessed pooled data using a random effects model. Of 5,842 potential articles, 100 studies of diverse quality were included, comprising 6,908,440 patients. Global mean(95%CI) CKD prevalence of 5 stages 13·4%(11·7–15·1%), and stages 3–5 was 10·6%(9·2–12·2%). Weighting by study quality did not affect prevalence estimates. CKD prevalence by stage was Stage-1 (eGFR>90+ACR>30): 3·5% (2·8–4·2%); Stage-2 (eGFR 60–89+ACR>30): 3·9% (2·7–5·3%); Stage-3 (eGFR 30–59): 7·6% (6·4–8·9%); Stage-4 = (eGFR 29–15): 0·4% (0·3–0·5%); and Stage-5 (eGFR<15): 0·1% (0·1–0·1%). CKD has a high global prevalence with a consistent estimated global CKD prevalence of between 11 to 13% with the majority stage 3. Future research should evaluate intervention strategies deliverable at scale to delay the progression of CKD and improve CVD outcomes.

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Author and article information

Contributors

Jennifer A. Hirst:

ORCID: https://orcid.org/0000-0002-8416-2159

Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

José M. Ordóñez Mena: Role: Formal analysisRole: InvestigationRole: MethodologyRole: ValidationRole: Writing – review & editing

Chris A. O’Callaghan:

ORCID: https://orcid.org/0000-0001-9962-3248

Role: ConceptualizationRole: Funding acquisitionRole: SupervisionRole: VisualizationRole: Writing – review & editing

Emma Ogburn: Role: Data curationRole: InvestigationRole: Project administrationRole: Writing – review & editing

Clare J. Taylor: Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: VisualizationRole: Writing – review & editing

Yaling Yang: Role: Writing – review & editing

F. D. Richard Hobbs: Role: ConceptualizationRole: Funding acquisitionRole: Project administrationRole: SupervisionRole: VisualizationRole: Writing – review & editing

Giuseppe Remuzzi: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS One

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 15 January 2021

Publication date Collection: 2021

Volume: 16

Issue: 1

Electronic Location Identifier: e0245131

Affiliations

[1 ] Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Observatory Quarter, Oxford, United Kingdom

[2 ] National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom

[3 ] Nuffield Dept Medicine, University of Oxford, Oxford, United Kingdom

Istituto Di Ricerche Farmacologiche Mario Negri, ITALY

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: jennifer.hirst@ 123456phc.ox.ac.uk

Author information

Jennifer A. Hirst https://orcid.org/0000-0002-8416-2159

Chris A. O’Callaghan https://orcid.org/0000-0001-9962-3248

Article

Publisher ID: PONE-D-20-32945

DOI: 10.1371/journal.pone.0245131

PMC ID: 7810320

PubMed ID: 33449936

SO-VID: 742b84a6-bda5-4a1e-80f7-374523eef070

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 20 October 2020

Date accepted : 22 December 2020

Page count

Figures: 2, Tables: 4, Pages: 14

Funding

Funded by: funder-id http://dx.doi.org/10.13039/501100013373, NIHR Oxford Biomedical Research Centre;

Award Recipient : Richard Hobbs

This work was supported in the form of funding by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) awarded to JH and JOM, NIHR Community Healthcare MedTECH and In vitro Diagnostic Cooperative (MIC) awarded to DSL, and an NIHR Academic Clinical Lectureship awarded to CT. This work was also supported partially by the NIHR School for Primary Care Research (SPCR), the NIHR Collaboration for Leadership in Applied Research in Health and Care (CLARHC) Oxford, and the NIHR Oxford Biomedical Research Centre (OUHT BRC) for FDRH. This work is also partially supported by the NIHR Collaboration for Leadership in Applied Research in Health and Care (CLARHC) Oxford for RJM.

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Data Availability Data cannot be shared publicly because of sensitive clinical data on potentially-identifiable human subjects. Data are available from the University of Oxford (contact via email to: information.guardian@ 123456phc.ox.ac.uk ) for researchers who meet the criteria for access to confidential data.

Prevalence and factors associated with multimorbidity among primary care patients with decreased renal function

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Abstract

Objectives

Design and setting

Participants

Interventions

Primary and secondary outcome measures

Results

Conclusions

Related collections

PLOS Climate

Most cited references 41

A new equation to estimate glomerular filtration rate.

Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.

Global Prevalence of Chronic Kidney Disease – A Systematic Review and Meta-Analysis

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