Cardiometabolic multimorbidity ups risk of major adverse kidney events

Among patients with chronic kidney disease, the risk of major adverse events such as renal function deterioration and need for kidney replacement therapy (KRT), among others, is high in the presence of two or more long-term conditions (LTCs), including hypertension and diabetes, a study has found.

The analysis included 68,505 participants from the UK Biobank cohort. Of these, 33 percent had one LTC, 19.6 percent had two, and 14.8 percent had three or more; the remaining 32.6 percent had no LTCs. Those with more vs zero LCT tended to be older, female, of White ethnicity, smokers, with less alcohol consumption, have lower physical activity levels, and higher body mass index, among others.

Over a median follow-up period of 12.0 years, 2,963 participants developed major adverse kidney events (MAKE; defined as the need for long-term KRT, doubling of serum creatinine, fall of estimated glomerular filtration rate [eGFR] to <15 ml/min/1.73 m², or 30-percent decline in eGFR).

MAKE was associated with LTC count categories. The corresponding adjusted subhazard ratios [sHRs] were 1.29 (95 percent confidence interval [CI], 1.15–1.45) with one LTC, 1.74 (95 percent CI, 1.55–1.96) with two LTCs, and 2.41 (95 percent CI, 2.14–2.71) with at least three LTCs.

The association was stronger when only cardiometabolic LTCs (hypertension, coronary heart disease, peripheral vascular disease, atrial fibrillation, diabetes, heart failure, and stroke) were considered. The sHRs for MAKE were 1.58 (95 percent CI, 1.45–1.73) with one LTC, 3.17 (95 percent CI, 2.80–3.59) with two LTCs, and 5.24 (95 percent CI, 4.34–6.33) with at least three LTCs.

Of note, diabetes, hypertension, and coronary heart disease were commonly seen in high-risk LTC combinations.