RT Journal Article
SR Electronic
T1 Comorbidity in chronic kidney disease: a large cross-sectional study of prevalence in Scottish primary care
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e243
OP e249
DO 10.3399/bjgp20X714125
VO 71
IS 704
A1 Clare MacRae
A1 Stewart W Mercer
A1 Bruce Guthrie
A1 David Henderson
YR 2021
UL http://bjgp.org/content/71/704/e243.abstract
AB Background Chronic kidney disease (CKD) is commonly comorbid with hypertension, diabetes, and cardiovascular disease (CVD). However, the extent of comorbidity in CKD across a range of concordant (shared pathophysiology and/or treatment) conditions and discordant (unrelated pathophysiology and/or different or contradictory treatment) conditions is not well documented.Aim To ascertain the prevalence of comorbidity, across 39 physical and mental health comorbidities, in adults with CKD in a large, nationally representative primary care population.Design and setting Cross-sectional analysis of a primary care dataset representing 1 274 374 adults in Scotland.Method This study was a secondary analysis of general practice electronic medical record data using binary logistic regression models adjusted for age, sex, and socioeconomic status. Data of adults aged ≥25 years and 40 long-term conditions were used.Results A total of 98.2% of adults with CKD had at least one comorbidity, versus 51.8% in controls. After adjustment for age, sex, and deprivation, people with CKD were more likely to have 1 (adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] = 6.0 to 7.1), 2–3 (aOR 15.2, 95% CI = 14.0 to 16.5), 4–6 (odds ratio [OR] 26.6, 95% CI = 24.4 to 28.9), and ≥7 other conditions (OR 41.9, 95% CI = 38.3 to 45.8). Furthermore, all concordant (seven out of seven), the majority of discordant physical health conditions (17 out of 24), and mental health conditions (six out of eight) had statistically significant positive associations with CKD after adjustment.Conclusion Chronic kidney disease is associated with extreme comorbidity across a wide range of mental and physical conditions. Routine care for people with CKD should include recognition and management of comorbidities, and clinical guidelines should support clinicians to do this.