Associations between multimorbidity and adverse clinical outcomes in patients with chronic kidney disease: a systematic review and meta-analysis

Sullivan, M. , Rankin, A. , Jani, B. D. , Mair, F. S. and Mark, P. B. (2020) Associations between multimorbidity and adverse clinical outcomes in patients with chronic kidney disease: a systematic review and meta-analysis. BMJ Open, (Accepted for Publication)

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Abstract

Objective: To systematically review the literature exploring the associations between multimorbidity (the presence of two or more long term conditions (LTCs)) and adverse clinical outcomes in patients with chronic kidney disease (CKD). Design: Systematic Review and Meta-analysis. Data sources: MEDLINE, EMBASE, CINAHL, Cochrane Library and SCOPUS (1946-2019). The main search terms were “Chronic Kidney Failure” and “Multimorbid*”. Eligibility Criteria: Observational studies of adults over the age of 18 with CKD stages three to five i.e. eGFR less than 60ml/minute/1.73m2. The exposure was Multimorbidity quantified by Measures and the outcomes were all-cause mortality, renal progression, hospitalisation and cardiovascular events. We did not consider CKD as a co-morbid LTC. Data Extraction and Synthesis: Newcastle Ottawa Scale for quality appraisal and risk of bias assessment and fixed-effects meta-analysis for data synthesis. Results: Of 1852 papers identified, 26 met the inclusion criteria. 21 papers involved patients with advanced CKD and no studies were from low or middle income countries. All-cause mortality was an outcome in all studies. Patients with multimorbidity were at higher risk of mortality compared to patients without multimorbidity (Total risk ratio 2.28 (95% confidence interval 1.81-2.88)). The risk of mortality was higher with increasing multimorbidity (Total hazard ratio 1.31 (1.27-1.36)) and both concordant and discordant LTCs were associated with heightened risk. Multimorbidity was associated with renal progression in four studies, hospitalisation in five studies and cardiovascular events in two studies. Limitations: Meta-analysis could only include 10 of 26 papers as the methodologies of studies were heterogeneous. Conclusions: There are associations between multimorbidity and adverse clinical outcomes in patients with CKD. However, most data relate to mortality risk in patients with advanced CKD. There is limited evidence regarding patients with mild to moderate CKD, outcomes such as cardiovascular events, types of LTCs and regarding patients from low or middle income countries. Prospero Registration: CRD42019147424.

Item Type:Articles
Status:Accepted for Publication
Refereed:Yes
Glasgow Author(s) Enlighten ID:Jani, Dr Bhautesh and Mark, Dr Patrick and Sullivan, Dr Michael and Rankin, Dr Alastair and Mair, Professor Frances
Authors: Sullivan, M., Rankin, A., Jani, B. D., Mair, F. S., and Mark, P. B.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
Journal Name:BMJ Open
Publisher:BMJ Publishing Group
ISSN:2044-6055
ISSN (Online):2044-6055
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in BMJ Open 2020
Publisher Policy:Reproduced under a Creative Commons License

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