Kidney Week

Abstract: TH-PO530

Multimorbidity and Race/Ethnicity in CKD

Session Information

• CKD: Health Services, Disparities, Prevention
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Chronic Kidney Disease (Non-Dialysis)

• 307 CKD: Health Services, Disparities, Prevention

Authors

• Walther, Carl P., Baylor College of Medicine, Houston, Texas, United States

Carl P. Walther,

• Niu, Jingbo, Baylor College of Medicine, Houston, Texas, United States

Jingbo Niu,

• Yan, Jingyin, Baylor College of Medicine, Houston, Texas, United States

Jingyin Yan,

• Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States

Wolfgang C. Winkelmayer,

• Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States

Sankar D. Navaneethan,

Background

Multimorbidity is common in CKD. It increases treatment burden and complexity, can result in conflicting therapies, and is associated with adverse outcomes. This may be especially important in socioeconomically disadvantaged populations. We examined the demographics of multimorbidity in a diverse, disadvantaged, non-dialysis CKD cohort.

Methods

We identified adults with eGFR <60 ml/min/1.73 m² for ≥90 days who received care through an urban safety-net health care system from 2006-16. ICD codes for chronic conditions (excluding CKD) prior to or within two weeks of cohort entry were identified and categorized into 21 groups. The relationships of comorbidity patterns with demographics and CKD stage (3A, 3B, 4, and 5) were studied. Multimorbidity was defined as 2 or more chronic conditions in addition to CKD. Race/ethnicity was recorded in 5 mutually-exclusive categories. We used proportions with binomial confidence intervals in stratified analyses, and multivariate logistic regression, to study relationships.

Results

We identified 13,678 patients, of whom 39.4% were Hispanic, 40.9% black, 11.5% white, 5.9% Asian/Pacific Islander, and 2.2% other/unknown. Comorbidity count (excluding CKD) ranged from 0 to 10, with median [interquartile range] of 2 [1,3]. Multimorbidity varied markedly by race/ethnicity and age (Figure). The logistic regression model (adjusted for gender, CKD stage, and year of cohort entry) corroborated this interaction (likelihood ratio test: p < 0.001). Among those aged 18-34, blacks or whites had slightly higher diabetes and HTN prevalences than Hispanics, compared with 10-fold higher HIV prevalence, and 4-fold higher depression and CHF.

Conclusion

Multimorbidity among young adults with non-dialysis CKD varies markedly by race/ethnicity, with lower prevalence among Hispanics than blacks or whites. This may be due to differences in CKD etiology, disparities in access to care, and other factors which warrant further investigation.