Multimorbidity and the risk of major adverse kidney events: findings from the UK Biobank cohort

Sullivan, M. K. et al. (2021) Multimorbidity and the risk of major adverse kidney events: findings from the UK Biobank cohort. Clinical Kidney Journal, 14(11), pp. 2409-2419. (doi: 10.1093/ckj/sfab079) (PMCID:PMC8573008)

Abstract

Background: Multimorbidity (the presence of two or more long-term conditions) is associated with a heightened risk of mortality, but little is known about its relationship with the risk of kidney events. Methods: Associations between multimorbidity and major adverse kidney events (MAKE: the need for long-term kidney replacement therapy, doubling of serum creatinine, fall of estimated glomerular filtration rate (eGFR) to < 15 ml/min/1.73m2 or 30% decline in eGFR) were studied in 68,505 participants from the UK Biobank cohort. Participants were enrolled in the study between 2006 and 2010. Associations between long-term condition counts and MAKE were tested using survival analyses accounting for the competing risk of death. Results: Over a median follow-up period of 12.0 years, 2,963 participants had MAKE. There were associations between long-term condition count categories and the risk of MAKE (one long-term condition adjusted subhazard ratio (sHR) 1.29 (95% Confidence Interval 1.15-1.45), 2 long-term conditions sHR 1.74 (1.55-1.96), three or more long-term conditions sHR 2.41 (2.14-2.71)). This finding was more pronounced when only cardiometabolic long-term conditions were considered (one long-term condition sHR 1.58 (1.45-1.73), two long-term conditions sHR 3.17 (2.80-3.59), three or more long-term conditions sHR 5.24 (4.34-6.33)). Combinations of long-term conditions associated with MAKE were identified. Diabetes, hypertension and coronary heart disease featured most commonly in high-risk combinations. Conclusions: Multimorbidity, and in particular cardiometabolic multimorbidity, is a risk factor for MAKE. Future research should study groups of patients who are at high risk of progressive kidney disease based on the number and type of long-term conditions.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Nicholl, Dr Barbara and Sullivan, Dr Michael and Lees, Jennifer and Welsh, Dr Claire and Stanley, Miss Bethany and McConnachie, Professor Alex and Jani, Dr Bhautesh and Mark, Professor Patrick and Welsh, Professor Paul and Mair, Professor Frances and Sattar, Professor Naveed and Lyall, Dr Donald
• Authors: Sullivan, M. K., Jani, B. D., Lees, J. S., Welsh, C. E., McConnachie, A., Stanley, B., Welsh, P., Nicholl, B. I., Lyall, D. M., Carrero, J.-J., Nitsch, D., Sattar, N., Mair, F. S., and Mark, P. B.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: Clinical Kidney Journal
• Publisher: Oxford University Press
• ISSN: 2048-8505
• ISSN (Online): 2048-8513
• Published Online: 11 April 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in Clinical Kidney Journal 14(11): 2409-2419
• Publisher Policy: Reproduced under a Creative Commons License

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
309978		Tackling the challenge of multimorbidity in chronic kidney disease	Michael Sullivan	Medical Research Council (MRC)	MR/V001671/1	CAMS - Cardiovascular Science