Beridze Giorgi, Dai Lu, Carrero Juan-Jesús, Marengoni Alessandra, Vetrano Davide L, Calderón-Larrañaga Amaia
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
J Am Geriatr Soc. 2025 Mar;73(3):837-848. doi: 10.1111/jgs.19298. Epub 2024 Dec 17.
Individual chronic conditions have been linked to kidney function decline; however, the role of multimorbidity (the presence of ≥2 conditions) and multimorbidity patterns remains unclear.
A total of 3094 individuals from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) were followed for 15 years. Multimorbidity was operationalized as the number of chronic conditions and multimorbidity patterns identified using latent class analysis (LCA). Joint models and Cox regression models were used to explore the associations between multimorbidity, and subsequent absolute and relative (≥25% decline from baseline) changes, respectively, in the estimated glomerular filtration rate (eGFR) calculated using the creatinine-based Berlin Initiative Study equation.
Mean age of the sample was 73.9, and 87% had multimorbidity. There was an independent dose-response relationship between the number of chronic conditions, and absolute (β [95% confidence interval, CI] = -0.05 [-0.07; -0.03]) and relative (hazard ratio, HR [95% CI] = 1.23 [1.17; 1.29]) declines in eGFR. Five patterns of multimorbidity were identified. The Unspecific, low burden pattern had the lowest morbidity burden and was used as the reference category. The Unspecific, high burden, and Cardiometabolic patterns showed accelerated absolute (β [95% CI] = -0.15 [-0.26; -0.05] and -0.77 [-0.98; -0.55], respectively) and relative (HR [95% CI] = 1.45 [1.09; 1.92] and 3.45 [2.27; 5.23], respectively) declines. Additionally, the Cognitive and Sensory pattern showed accelerated relative decline (HR [95% CI] = 1.53 [1.02; 2.31]). No associations were found for the Psychiatric and Respiratory pattern.
Multimorbidity is strongly associated with accelerated kidney function decline in older age. Individuals with cardiometabolic multimorbidity exhibit a particularly increased risk. Increased monitoring and timely interventions may preserve kidney function and reduce cardiovascular risks in individuals presenting with conditions that are characteristic of high-risk multimorbidity patterns.
个体慢性疾病与肾功能下降有关；然而，多种疾病并存（存在≥2种疾病）及其模式的作用仍不明确。
对瑞典 Kungsholmen 地区国家老龄化与护理研究（SNAC-K）中的 3094 名个体进行了为期 15 年的随访。多种疾病并存通过慢性病数量来衡量，并使用潜在类别分析（LCA）确定多种疾病并存模式。分别使用联合模型和 Cox 回归模型来探讨多种疾病并存与随后使用基于肌酐的柏林倡议研究方程计算的估计肾小球滤过率（eGFR）的绝对变化和相对变化（较基线下降≥25%）之间的关联。
样本的平均年龄为 73.9 岁，87%的人患有多种疾病。慢性病数量与 eGFR 的绝对下降（β[95%置信区间，CI]= -0.05[-0.07；-0.03]）和相对下降（风险比，HR[95%CI]= 1.23[1.17；1.29]）之间存在独立的剂量反应关系。确定了五种多种疾病并存模式。非特异性低负担模式的发病负担最低，用作参考类别。非特异性高负担模式和心脏代谢模式显示出加速的绝对下降（β[95%CI]分别为 -0.15[-0.26；-0.05]和 -0.77[-0.98；-0.55]）和相对下降（HR[95%CI]分别为 1.45[1.09；1.92]和 3.45[2.27；5.23]）。此外，认知和感觉模式显示出加速的相对下降（HR[95%CI]= 1.53[1.02；2.31]）。未发现精神和呼吸模式存在关联。
多种疾病并存与老年人群肾功能加速下降密切相关。患有心脏代谢多种疾病的个体风险尤其增加。对于具有高风险多种疾病并存模式特征疾病的个体，加强监测和及时干预可能有助于保护肾功能并降低心血管风险。
