FP351THE BURDEN AND SURVIVAL IMPLICATIONS OF COMORBIDITY IN PEOPLE WITH CHRONIC KIDNEY DISEASE STAGE 3

Abstract

Introduction and Aims: Multimorbidity is a growing concern for health and social care systems due to demographic and epidemiological transition. Chronic kidney disease (CKD) is common but the extent and prognostic significance of its comorbidities is not well understood. This study describes the prevalence and survival implications of eleven comorbidities (and the associated medication burden) in a cohort of people with CKD stage 3 in a primary care setting. Method(s): A prospective cohort of 1741 people with CKD stage 3 was recruited from primary care between August 2008 and March 2010. Participants underwent medical history, clinical assessment, blood and urine sampling for biochemistry. Self-reported comorbidity and medication burden was described and a Kaplan Meier plot and multivariable Cox proportional hazards models (adjusted for age, sex, smoking and eGFR) were used to investigate associations between comorbidity and all-cause mortality. Result(s): 1741 people were recruited, mean age 73 +/-9 years. 67% were over 70. Only 78/1741 (4%) had no comorbidities, 453/1741 (26%) had one comorbidity, 508/1741 (29%) had two comorbidities and 702/1741 (40%) had over two comorbidities. Hypertension was almost ubiquitous (88%). The next commonest were painful condition 30%, anaemia 24%, ischaemic heart disease 23%, diabetes 17% and thyroid 12%). Individual comorbidity distribution varied by degree of comorbidity (Fig 1).175/1741 (10%) died after median 3.6 years of follow up, most commonly from cardiovascular disease (41%). Greater degree of comorbidity was independently associated with all-cause mortality (hazard ratio 2.74 (95% CI 1.69-4.48, p<0.001 for over 2 vs 0 or 1). 25% of those with more than 2 comorbidities were taking 10 or more medications vs 0.4% of those with 0 or 1 comorbidity (p<0.001 for trend). Conclusion(s): Isolated CKD was rare and whilst vascular comorbid conditions were common there was a diverse range of comorbidities in this cohort of people with moderate CKD from primary care. The extent of multimorbidity was associated with medication burden and poorer survival. Integrated care for people with CKD should. (Figure Presented).