Multiple comorbidities may increase the risk of early dialysis initiation among patients with chronic kidney disease (CKD), according to a new study.

In a study of 1463 patients with stage 3–5 CKD who had a mean follow-up time of 6.39 years, those with at least 3 comorbidities had a 3-fold greater risk of dialysis initiation compared with those who had no comorbidities, Wen-Chin Lee, MD, and colleagues from Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine in Kaohsiung, Taiwan, reported in the Journal of Clinical Medicine.

Older age, smoking, and proteinuria significantly increased the risk of have multiple (2 or more) comorbidities. The odds of having multiple comorbidities were 1.7-fold greater among patients older than 65 years compared with younger patients, 1.5-fold greater among those with vs without proteinuria, and 2-fold greater among current smokers compared with nonsmokers.

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“The determination of the number of comorbidities in patients provides a simple, readily applicable, and valid method for classifying comorbidities and predicting renal outcomes in patients with stage 3–5 CKD,” the investigators concluded. “The number of comorbidities present should be considered when making tailored patient care plans.”

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Of the 1463 patients, 41.9% had multiple comorbidities and 94 died during follow-up. The 10-year survival renal survival rates were 94.9%, 91.1%, 94.4%, and 89.1% among patients with 0, 1, 2, and 3 or more comorbidities, respectively. The investigators included 12 comorbidities in their study. The 3 most common comorbidities were hypertension, diabetes, hyperlipidemia, which were present in 66.8%, 32.4%, and 12.3% of patients, respectively. The other comorbidities were cerebrovascular disease, malignancy, liver disease, anemia, ischemic heart disease, gout, connective tissue disease, congestive heart failure, and tuberculosis.


Lee WC, Lee YT, Li LC, et al. The number of comorbidities predicts renal outcomes in patients with stage 3–5 chronic kidney disease. J Clin Med. 2018;7:493.