Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr 11;14(11):2409-2419.
doi: 10.1093/ckj/sfab079. eCollection 2021 Nov.

Multimorbidity and the risk of major adverse kidney events: findings from the UK Biobank cohort

Michael K Sullivan  1 , Bhautesh Dinesh Jani  2 , Jennifer S Lees  1 , Claire E Welsh  3 , Alex McConnachie  4 , Bethany Stanley  4 , Paul Welsh  1 , Barbara I Nicholl  2 , Donald M Lyall  5 , Juan-Jesus Carrero  6 , Dorothea Nitsch  7 , Naveed Sattar  1 , Frances S Mair  2 , Patrick B Mark  1
Affiliations

Multimorbidity and the risk of major adverse kidney events: findings from the UK Biobank cohort

Michael K Sullivan et al. Clin Kidney J. .

Abstract

Background: Multimorbidity [the presence of two or more long-term conditions (LTCs)] is associated with a heightened risk of mortality, but little is known about its relationship with the risk of kidney events.

Methods: Associations between multimorbidity and major adverse kidney events [MAKE: the need for long-term kidney replacement therapy, doubling of serum creatinine, fall of estimated glomerular filtration rate (eGFR) to <15 mL/min/1.73 m2 or 30% decline in eGFR] were studied in 68 505 participants from the UK Biobank cohort. Participants were enrolled in the study between 2006 and 2010. Associations between LTC counts and MAKE were tested using survival analyses accounting for the competing risk of death.

Results: Over a median follow-up period of 12.0 years, 2963 participants had MAKE. There were associations between LTC count categories and the risk of MAKE [one LTC adjusted subhazard ratio (sHR) = 1.29, 95% confidence interval (CI) 1.15-1.45; two LTCs sHR = 1.74 (95% CI 1.55-1.96); and three or more LTCs sHR = 2.41 (95% CI 2.14-2.71)]. This finding was more pronounced when only cardiometabolic LTCs were considered [one LTC sHR = 1.58 (95% CI 1.45-1.73); two LTCs sHR = 3.17 (95% CI 2.80-3.59); and three or more LTCs sHR = 5.24 (95% CI 4.34-6.33)]. Combinations of LTCs associated with MAKE were identified. Diabetes, hypertension and coronary heart disease featured most commonly in high-risk combinations.

Conclusions: Multimorbidity, and in particular cardiometabolic multimorbidity, is a risk factor for MAKE. Future research should study groups of patients who are at high risk of progressive kidney disease based on the number and type of LTCs.

Keywords: cardiometabolic; comorbidity; condition clusters; kidney outcomes; mortality; multimorbidity.

PubMed Disclaimer

Figures

GRAPHICAL ABSTRACT
GRAPHICAL ABSTRACT
FIGURE 1:
FIGURE 1:
Cumulative incidence of outcomes by LTC count category.
FIGURE 2:
FIGURE 2:
Cumulative incidence of outcomes by cardiometabolic LTC count category.
See this image and copyright information in PMC

References

    1. Multimorbidity: a priority for global health research. Acad Med Sci 2018. https://acmedsci.ac.uk/file-download/82222577.
    1. MacMahon S, Paul Elliott P, Naomi P. Advancing research to tackle multimorbidity: the UK and LMIC perspectives. 2018. https://acmedsci.ac.uk/file-download/11182404 (30 April 2020, date last accessed)
    1. Gallacher KI, Batty GD, McLean Get al. . Stroke, multimorbidity and polypharmacy in a nationally representative sample of 1,424,378 patients in Scotland: implications for treatment burden. BMC Med 2014; 12: 151 - PMC - PubMed
    1. Mair FS, May CR.. Thinking about the burden of treatment. BMJ Br Med J 2014; 349: g6680 - PubMed
    1. Makovski TT, Schmitz S, Zeegers MPet al. . Multimorbidity and quality of life: systematic literature review and meta-analysis. Ageing Res Rev 2019; 53: 1568–1637 - PubMed