Associations between multimorbidity and kidney function decline in old age: A population-based cohort study

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2024-12-17 DOI:10.1111/jgs.19298

Giorgi Beridze MD, MMSc, Lu Dai MD, PhD, Juan-Jesús Carrero MPharm, PhD, Alessandra Marengoni MD, PhD, Davide L. Vetrano MD, PhD, Amaia Calderón-Larrañaga MPharm, MPH, PhD

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引用次数: 0

Abstract

Background

Individual chronic conditions have been linked to kidney function decline; however, the role of multimorbidity (the presence of ≥2 conditions) and multimorbidity patterns remains unclear.

Methods

A total of 3094 individuals from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) were followed for 15 years. Multimorbidity was operationalized as the number of chronic conditions and multimorbidity patterns identified using latent class analysis (LCA). Joint models and Cox regression models were used to explore the associations between multimorbidity, and subsequent absolute and relative (≥25% decline from baseline) changes, respectively, in the estimated glomerular filtration rate (eGFR) calculated using the creatinine-based Berlin Initiative Study equation.

Results

Mean age of the sample was 73.9, and 87% had multimorbidity. There was an independent dose–response relationship between the number of chronic conditions, and absolute (β [95% confidence interval, CI] = −0.05 [−0.07; −0.03]) and relative (hazard ratio, HR [95% CI] = 1.23 [1.17; 1.29]) declines in eGFR. Five patterns of multimorbidity were identified. The Unspecific, low burden pattern had the lowest morbidity burden and was used as the reference category. The Unspecific, high burden, and Cardiometabolic patterns showed accelerated absolute (β [95% CI] = −0.15 [−0.26; −0.05] and −0.77 [−0.98; −0.55], respectively) and relative (HR [95% CI] = 1.45 [1.09; 1.92] and 3.45 [2.27; 5.23], respectively) declines. Additionally, the Cognitive and Sensory pattern showed accelerated relative decline (HR [95% CI] = 1.53 [1.02; 2.31]). No associations were found for the Psychiatric and Respiratory pattern.

Conclusion

Multimorbidity is strongly associated with accelerated kidney function decline in older age. Individuals with cardiometabolic multimorbidity exhibit a particularly increased risk. Increased monitoring and timely interventions may preserve kidney function and reduce cardiovascular risks in individuals presenting with conditions that are characteristic of high-risk multimorbidity patterns.

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老年多病症与肾功能衰退之间的关系：一项基于人群的队列研究。

背景：个别慢性疾病与肾功能下降有关；然而，多重发病（存在≥2种病症）和多重发病模式的作用仍不清楚。方法：对3094名来自瑞典国家Kungsholmen老龄化与护理研究（SNAC-K）的个体进行为期15年的随访。多病被操作为使用潜在类别分析（LCA）确定的慢性病和多病模式的数量。联合模型和Cox回归模型分别用于探讨多发病与随后使用基于肌酐的柏林倡议研究方程计算的估计肾小球滤过率（eGFR）的绝对和相对（从基线下降≥25%）变化之间的关系。结果：本组患者平均年龄为73.9岁，87%有多病。慢性疾病的数量与绝对(β[95%置信区间，CI] = -0.05 [-0.07；-0.03])和相对(风险比，HR [95% CI] = 1.23 [1.17；[1.29]) eGFR下降。确定了五种多重发病模式。非特异性、低负担模式的发病率负担最低，作为参考类别。非特异性、高负荷和心脏代谢模式显示绝对加速(β [95% CI] = -0.15 [-0.26；-0.05]和-0.77 [-0.98；-0.55])和相对(HR [95% CI] = 1.45 [1.09；1.92]和3.45 [2.27；5.23])下降。此外，认知和感觉模式表现出加速的相对下降(HR [95% CI] = 1.53 [1.02；2.31])。没有发现精神病学和呼吸模式之间的关联。结论：多病与老年肾功能加速下降密切相关。患有心脏代谢多发病的个体表现出特别高的风险。加强监测和及时干预可以保护肾功能，降低具有高危多病模式特征的个体的心血管风险。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.