Abstract: PO2414
Association of Multimorbidity and Mortality Risk in US Veterans with New-Onset CKD
Session Information
- CKD: Qualitative and Quantitative Observational Studies
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Burrows, Nilka Rios, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Choudhury, Devasmita, VA Medical Center Salem, Salem, Virginia, United States
- Yu, Wei, University of Virginia School of Medicine, Charlottesville, Virginia, United States
- Koyama, Alain, 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., VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
- Norris, Keith C., University of California Los Angeles, Los Angeles, California, United States
- Yan, Guofen, University of Virginia School of Medicine, Charlottesville, Virginia, United States
Background
Many patients with CKD live with multiple chronic conditions. We examined the association of multimorbidity at CKD onset and the 10-year risk of death in US veterans with incident CKD.
Methods
The cohort included 892,005 veterans with new-onset CKD (estimated GFR<60 mL/min/1.73 m2 for >3 months) between 2004 and 2018 in the US Veterans Health Administration, followed for up to 10 years or December 31, 2018. Multimorbidity was measured by the total number of comorbidities among 16 conditions based on ICD-9/ICD-10 codes during the 2 years before and up to 6 months after CKD onset, and categorized as 0–1, 2, 3, 4, 5, 6, 7, and ≥8 conditions. We estimated mortality risk by age groups at CKD onset.
Results
The median number of comorbidities at CKD onset was 4 (interquartile range: 3-6). After multivariable adjustment, the association between increasing multimorbidity and mortality risk was seen in all age groups, but was stronger in younger than older groups (Table). Death risk when having ≥5 comorbidities was >8-fold higher in ages 18-44, but only >2-fold higher in ages 85-100, compared to their age counterparts with 0-1 comorbidity. Multimorbidity patterns also differed by age. For example, among those with only 2 concurrent comorbidities, hypertension and depression co-occurred most frequently in ages 18-44, as compared to hypertension and cardiovascular disease in older age groups.
Conclusion
At CKD onset, 95% of patients had multiple comorbidities. The association of multimorbidity and mortality was greater for younger patients. Effective plans for early CKD diagnosis and timely treatment of comorbidities may improve survival in CKD, especially for younger patients.
Hazard ratios (95% CI) of death across multimorbidity categories at CKD onset
| Number of comorbidities at CKD onset | Percent of patients in each category | Ages 18-44 | Ages 45-64 | Ages 65-84 | Ages 85-100 |
| 0-1 | 5.2 | 1 | 1 | 1 | 1 |
| 2 | 11.8 | 2.7 (1.4-5.5) | 1.8 (1.6-1.9) | 1.4 (1.4-1.5) | 1.2 (1.1-1.2) |
| 3 | 18.0 | 3.8 (2.0-7.5) | 2.6 (2.4-2.8) | 1.9 (1.8-1.9) | 1.4 (1.4-1.5) |
| 4 | 19.3 | 5.9 (3.1-11.4) | 3.5 (3.3-3.8) | 2.4 (2.3-2.4) | 1.7 (1.6-1.8) |
| 5 | 16.7 | 8.5 (4.4-16.2) | 4.6 (4.3-5.0) | 3.0 (3.0-3.1) | 2.1 (2.0-2.2) |
| 6 | 12.4 | 10.5 (5.4-20.2) | 5.8 (5.4-6.3) | 3.7 (3.6-3.8) | 2.5 (2.3-2.6) |
| 7 | 8.1 | 13.1 (6.7-25.5) | 7.4 (6.9-8.0) | 4.6 (4.5-4.8) | 3.0 (2.8-3.2) |
| ≥8 | 8.5 | 15.6 (8.1-30.1) | 10.8 (10.0-11.7) | 6.5 (6.3-6.7) | 3.9 (3.7-4.1) |
Funding
- NIDDK Support