Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
VA Salem Medical Center, Salem, Virginia, USA.
Am J Nephrol. 2022;53(8-9):652-662. doi: 10.1159/000526254. Epub 2022 Oct 7.
Mortality is an important long-term indicator of the public health impact of chronic kidney disease (CKD). We investigated the role of individual comorbidities and multimorbidity on age-specific mortality risk among US veterans with new-onset CKD.
The cohort included 892,005 veterans aged ≥18 years with incident CKD stage 3 between January 2004 and April 2018 in the US Veterans Health Administration (VHA) system and followed until death, December 2018, or up to 10 years. Incident CKD was defined as the first-time estimated glomerular filtration rate (eGFR) was <60 mL/min/1.73 m2 for >3 months. Comorbidities were ascertained using inpatient and outpatient clinical records in the VHA system and Medicare claims. We estimated death rates for any cardiovascular disease (CVD, a composite of 6 CVD conditions) and 15 non-CVD comorbidities, and adjusted risks of death (hazard ratio [HR], 95% confidence interval [CI]) overall and by age group at CKD incidence.
At CKD incidence, the mean age was 72 years, and 97% were male; the mean eGFR was 52 mL/min/1.73 m2, and 95% had ≥2 comorbidities (median, 4) in addition to CKD. During a median follow-up of 4.5 years, among the 16 comorbidities, CVD was associated with the highest relative risk of death in younger veterans (HR 1.96 [95% CI: 1.61-2.37] in ages 18-44 years and HR 1.66 [1.63-1.70] in ages 45-64 years). Dementia was associated with the highest relative risk of death among older veterans (HR 1.71 [1.68-1.74] in ages 65-84 years and HR 1.69 [1.65-1.73] in ages 85-100 years). The additive effect of multimorbidity on risk of death was stronger in younger than older veterans. Compared to having 1 or no comorbidity at CKD onset, the risk of death with ≥5 comorbidities was >7-fold higher among veterans aged 18-44 years and >2-fold higher among veterans aged 85-100 years.
The large burden of comorbidities in US veterans with newly identified CKD places them at the risk of premature death. Compared with older veterans, younger veterans with multiple comorbidities, particularly with CVD, at CKD onset are at an even higher relative risk of death.
死亡率是衡量慢性肾脏病（CKD）对公众健康影响的一个重要长期指标。我们研究了美国退伍军人新发生的 CKD 患者中，个体合并症和多种合并症对特定年龄死亡率的影响。
该队列包括 892005 名年龄≥18 岁的美国退伍军人健康管理局（VHA）系统中新发生的 CKD 3 期患者，这些患者在 2004 年 1 月至 2018 年 4 月期间首次出现估计肾小球滤过率（eGFR）<60 mL/min/1.73 m2，持续时间超过 3 个月。合并症通过 VHA 系统中的住院和门诊临床记录以及医疗保险索赔进行确定。我们估计了任何心血管疾病（CVD，6 种 CVD 疾病的综合）和 15 种非 CVD 合并症的死亡率，并按 CKD 发病时的年龄组调整死亡率（风险比[HR]，95%置信区间[CI]）。
在 CKD 发病时，平均年龄为 72 岁，97%为男性；平均 eGFR 为 52 mL/min/1.73 m2，95%的患者除 CKD 外还患有≥2 种合并症（中位数为 4 种）。在中位随访 4.5 年期间，在 16 种合并症中，心血管疾病与年轻退伍军人死亡风险相关性最高（18-44 岁年龄组 HR 1.96[95%CI：1.61-2.37]，45-64 岁年龄组 HR 1.66[1.63-1.70]）。痴呆与老年退伍军人的死亡风险相关性最高（65-84 岁年龄组 HR 1.71[1.68-1.74]，85-100 岁年龄组 HR 1.69[1.65-1.73]）。与 CKD 发病时只有 1 种或没有合并症相比，年轻退伍军人的多种合并症对死亡风险的累加效应更强。与 18-44 岁年龄组的退伍军人相比，与≥5 种合并症相关的死亡风险高出 7 倍以上，与 85-100 岁年龄组的退伍军人相比，死亡风险高出 2 倍以上。
在美国新确诊的 CKD 退伍军人中，大量的合并症使其面临过早死亡的风险。与老年退伍军人相比，在 CKD 发病时合并多种合并症，尤其是合并心血管疾病的年轻退伍军人，其死亡的相对风险更高。
