Comorbidities Increase Hospitalization Risk in CKD Patients

Besides hypertension and diabetes, ‘discordant’ co-existing illnesses as chronic pulmonary disease predict adverse outcomes.
Besides hypertension and diabetes, ‘discordant’ co-existing illnesses as chronic pulmonary disease predict adverse outcomes.

Co-existing conditions commonly lead to hospitalization for chronic kidney disease (CKD) patients, according to a new study.

In addition to hypertension and diabetes, which are among the most common comorbidities in CKD patients, “discordant” physical conditions, such as chronic pulmonary disease, as well as mental health disorders drive adverse events.

Marcello Tonelli, MD, of University of Calgary in Alberta, Canada, and colleagues determined the prevalence of 29 comorbidities among 530,771 CKD patients living in the province and linked them to hospitalizations, acute myocardial infarctions, and deaths.

Most CKD patients had 1 comorbidity, according to results published in Kidney International (2015;88:859-866). A quarter of patients, however, had 3 or more co-existing illnesses, and 7% had 5 or more. The investigators determined the proportion of hospitalizations that theoretically would not occur without the co-existing condition (population attributable risk) and determined that it was greater for hypertension, diabetes, stroke, atrial fibrillation, heart failure, chronic pulmonary disease, depression, chronic pain, schizophrenia, alcohol abuse, asthma, rheumatoid arthritis, inflammatory bowel disease, severe constipation, lymphoma, and non-metastatic and metastatic cancer.

“The presence of multiple comorbidities among people with CKD has implications for clinicians and guideline producers as well as for the patient themselves,” the researchers stated.

More attention should be directed toward management of these co-existing illnesses because of competing therapeutic goals with CKD, possible drug interactions, and the prospect of harm from overly aggressive treatment, according to the investigators. Study findings also suggest which healthcare professionals might be helpful to have on staff at CKD clinics.

The investigators were unable to determine the influence of medications, diet, exercise, smoking, weight, and other relevant factors. It also is possible that some patients had acute kidney injury rather than CKD.

Source

  1. Tonelli, M; Wiebe, N; Guthrie, B; et al. Kidney International (2015)88, 859-866; doi: 10.1038/ki.2015.228.
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