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Kidney Week

Abstract: PO2265

Trends in Prevalence of Comorbid Conditions at Onset of CKD Among US Veterans with Incident CKD, 2004-2018

Session Information

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, VA Medical Center Salem, Salem, Virginia, United States
  • Yu, Wei, University of Virginia School of Medicine, Charlottesville, Virginia, United States
  • Burrows, Nilka Rios, Centers for Disease Control and Prevention, Atlanta, Georgia, 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 comorbid conditions are strong risk factors for adverse outcomes in people with CKD. We examined trends in prevalence of major comorbidities at CKD onset in the US Veterans Health Administration (VHA).

Methods

Incident CKD was defined as the first time the estimated glomerular filtration rate (eGFR) decreased to <60 mL/min/1.73 m2 for >3 months. We excluded veterans recorded in the VHA for <2 years prior to the first eGFR <60, or with CKD stage ≥4 when first identified. We identified 15 comorbidities at CKD onset using ICD-9/ICD-10 codes during the 2 years before and 6 months after CKD onset and calculated the Charlson comorbidity index (CCI), a composite score of total disease burden.

Results

The cohort included 892,005 veterans with new-onset CKD between 2004 and 2018. The mean age (72 years), eGFR (52 mL/min/1.73m2), and body mass index (30 kg/m2) at CKD onset were similar in 2004 and in 2018. Among the 8 comorbidities with >20% prevalence (left panel, Table), hypertension, cardiovascular disease, chronic obstructive pulmonary disease, and cancer declined from 2004 to 2018, with the largest decline (21%) for cancer. Diabetes, anemia, depression, and obesity increased in prevalence, with the largest increases for obesity (58%) and depression (30%). The percentage of patients with a CCI ≥6 increased from 9% in 2004 to 14% in 2018.

Conclusion

In US veterans, obesity, depression and the CCI score have significantly increased at CKD onset over the recent 15 years, underscoring the importance of a multifaceted approach to management of CKD and its risk factors.

Prevalence of comorbidities at CKD onset among US veterans, 2004–2018
ComorbidityPrevalence (%)Percent change*ComorbidityPrevalence (%)Percent change*
2004201820042018
Hypertension91.789.3-2.6Gastrointestinal bleeding disorders17.910.9-39.0
Cardiovascular disease77.874.0-4.9Psychoses8.93.6-59.0
Diabetes46.051.311.6Alcohol abuse7.611.549.8
Chronic obstructive pulmonary disease34.633.9-1.9Dementia5.08.060.9
Anemia34.535.63.3Drug abuse4.47.367.5
Depression27.836.129.7Liver disease4.04.616.7
Cancer25.920.6-21.0HIV/AIDS0.40.7101.0
Obesity22.335.358.4Charlson comorbidity index (CCI) ≥ 68.914.462.2

*P-values were all <0.001, controlling for demographics.

Funding

  • NIDDK Support