Abstract: PO0514
Prevalence of Comorbid Conditions at CKD Onset Among US Veterans
Session Information
- CKD Health Services Research
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Pavkov, Meda E., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Choudhury, Devasmita, Salem VA Medical Center, Salem, Virginia, United States
- Yu, Wei, University of Virginia, Charlottesville, Virginia, United States
- Burrows, Nilka Rios, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
- Cheung, Alfred K., University of Utah Health, Salt Lake City, Utah, United States
- Norris, Keith C., University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
- Yan, Guofen, University of Virginia, Charlottesville, Virginia, United States
Background
Comorbid conditions such as hypertension (HTN) and diabetes increase risk of adverse outcomes among patients with CKD. It is less clear whether such conditions develop prior to CKD onset or subsequently emerge as the disease progresses. Using a newly constructed national incident CKD cohort, we examined the prevalence of major comorbidities at the time of CKD onset by demographic groups.
Methods
The cohort included 1,074,238 subjects with new-onset CKD between 2002 and 2017 in the US Veterans Health Administration (VHA). CKD onset was defined as the first time when estimated GFR (eGFR; CKD-EPI equation) decreased to a value <60 mL/min/1.73 m2 for >3 months. We excluded subjects in VHA for <2 years prior to first eGFR <60, or with CKD stage 4 or 5, or end-stage kidney disease (ESKD) when first identified. Thus, the first time identified was close to the onset of CKD stage 3. Comorbidities at CKD onset were ascertained from ICD-9/ICD-10 codes during any time before onset and through 6 months after onset.
Results
All subgroups (age, gender, race and ethnicity) had similar mean eGFRs at onset (51 ml/min/1.73m2). The percentage with age at onset ≤65 years was greater in males (74%) than females (43%), greater in Black (48%) than in American Indian or Alaska Native (39%), Asian or Pacific Islander (33%), and Hispanic (30%), which in turn were greater than Whites (23%). At CKD onset, HTN was highly prevalent, varying from 83% in females to 96% in Blacks; diabetes ranged from 36% in females to 61% in Hispanics; more than two-thirds had cardiovascular disease (CVD); and 19-28% had cancer across subgroups (Table).
Conclusion
This finding suggests that many veterans at the time of CKD onset had already developed some major comorbidities, which could make them particularly susceptible to death before ESKD.
Percentages of patients with the individual comorbidity at CKD onset
| Comorbidity | Age | Gender | Race and ethnicity | ||||||
| 18-65 years | >65 years | Female | Male | American Indian or Alaska Native | Asian or Pacific Islander | Black | Hispanic | White | |
| HTN | 89.6 | 90.1 | 82.6 | 90.2 | 89.4 | 90.8 | 95.5 | 92.0 | 89.0 |
| Diabetes | 52.3 | 44.0 | 35.7 | 46.6 | 54.8 | 51.9 | 55.4 | 60.6 | 43.9 |
| CVD | 68.0 | 77.4 | 64.2 | 75.2 | 73.4 | 68.6 | 71.7 | 71.3 | 75.6 |
| Chronic obstructive pulmonary disorder | 31.1 | 29.5 | 34.7 | 29.8 | 31.4 | 24.9 | 27.6 | 24.2 | 30.5 |
| Anemia | 31.1 | 29.9 | 33.2 | 30.1 | 31.3 | 25.7 | 42.3 | 36.2 | 28.1 |
| Cancer | 18.5 | 27.9 | 20.8 | 25.5 | 21.3 | 20.7 | 26.5 | 24.0 | 25.4 |
| Gastrointestinal bleeding disorders | 19.3 | 15.9 | 16.7 | 16.8 | 18.5 | 15.9 | 22.0 | 20.5 | 15.7 |
| Liver disease | 9.9 | 3.4 | 6.1 | 5.1 | 6.7 | 5.2 | 7.7 | 9.2 | 4.5 |
Funding
- NIDDK Support