NIHR Applied Research Collaboration (ARC) East Midlands, Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK.
Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK.
Int Urol Nephrol. 2023 Aug;55(8):2047-2057. doi: 10.1007/s11255-023-03516-1. Epub 2023 Feb 21.
Multimorbidity [defined as two or more long-term conditions (LTCs)] contributes to increased treatment and medication burden, poor health-related quality of life, and worse outcomes. Management strategies need to be patient centred and tailored depending on existing comorbidities; however, little is known about the prevalence and patterns of comorbidities in people with chronic kidney disease (CKD). We investigated the prevalence of multimorbidity and comorbidity patterns across all CKD stages.
Multimorbidity was assessed, using a composite of self-report and clinical data, across four CKD groups stratified by eGFR [stage 1-2, stage 3a&b, stage 4-5, and kidney transplant (KTx)]. Principal component analysis using varimax rotation was used to identify comorbidity clusters across each group.
Of the 978 participants (mean 66.3 ± 14 years, 60% male), 96.0% had multimorbidity. In addition to CKD, the mean number of comorbidities was 3.0 ± 1.7. Complex multimorbidity (i.e. ≥ 4 multiple LTCs) was identified in 560 (57.3%) participants. When stratified by CKD stage, the two most prevalent comorbidities across all stages were hypertension (> 55%) and musculoskeletal disorders (> 40%). The next most prevalent comorbidity for CKD stages 1-2 was lung conditions and for CKD stages 3 and 4-5 it was heart problems. CKD stages 1-2 showed different comorbidity patterns and clustering compared to other CKD stages.
Most people across the spectrum of CKD have multimorbidity. Different patterns of multimorbidity exist at different stages of CKD, and as such, clinicians should consider patient comorbidities to integrate care and provide effective treatment strategies.
多种疾病（定义为两种或两种以上的长期疾病（LTCs））会增加治疗和药物负担，降低健康相关生活质量，并导致更差的结局。管理策略需要以患者为中心，并根据现有合并症进行调整；然而，对于慢性肾脏病（CKD）患者的合并症患病率和模式知之甚少。我们调查了所有 CKD 阶段的多种疾病患病率和合并症模式。
使用自我报告和临床数据的组合，在按 eGFR 分层的四个 CKD 组（1-2 期、3a&b 期、4-5 期和肾移植（KTx））中评估多种疾病。使用方差极大旋转的主成分分析来确定每个组中的合并症聚类。
在 978 名参与者中（平均 66.3±14 岁，60%为男性），96.0%患有多种疾病。除了 CKD，平均合并症数量为 3.0±1.7。在 560 名（57.3%）参与者中确定了复杂的多种疾病（即≥4 种多种 LTCs）。按 CKD 阶段分层，所有阶段最常见的两种合并症是高血压（>55%）和肌肉骨骼疾病（>40%）。CKD 1-2 期的下一个最常见合并症是肺部疾病，而 CKD 3 期和 4-5 期的最常见合并症是心脏问题。CKD 1-2 期与其他 CKD 阶段表现出不同的合并症模式和聚类。
大多数 CKD 患者都有多病共存。CKD 不同阶段存在不同的多病共存模式，因此，临床医生应考虑患者的合并症，以整合护理并提供有效的治疗策略。
