Kidney Week

Abstract: PUB553

Association between Multimorbidity and the Risk of Major Adverse Cardiovascular Events and Mortality in Patients with Nondialysis-Dependent CKD

Session Information

• Publication Only

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Okamura, Kazuhiro, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan

Kazuhiro Okamura, MD

• Tanaka, Shigeru, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan

Shigeru Tanaka, MD, PhD

• Kitamura, Hiromasa, Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Fukuoka, Japan

Hiromasa Kitamura, MD, PhD

• Tsuruya, Kazuhiko, Department of Nephrology, Nara Medical University, Kashihara, Nara, Japan

Kazuhiko Tsuruya, MD, PhD

• Kitazono, Takanari, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan

Takanari Kitazono, MD, PhD

• Nakano, Toshiaki, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan

Toshiaki Nakano, MD, PhD

Background

Multimorbidity, defined as the coexistence of two or more comorbidities, is associated with poor life prognosis and the onset of cardiovascular disease among the general population. It remains unclear whether the accumulation of comorbidities, including non-cardiovascular comorbidities, is associated with poor prognosis in patients with chronic kidney disease (CKD), a high-risk group for cardiovascular risk.

Methods

We investigated 4,420 patients with non-dialysis CKD who participated in the Fukuoka Kidney disease Registry (FKR) study and had confirmed comorbidities at the time of research registration. We defined 23 comorbidities, including hypertension, diabetes, and dyslipidemia. Patients were divided into three groups based on the number of comorbidities: one or fewer (1265 patients), two (1205 patients), and three or more (1,950 patients). We assessed the association between the number of comorbidities and the incidence of major adverse cardiovascular events (MACE) (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) and all-cause mortality using the Cox proportional hazards model.

Results

During the five-year observation period, 229 patients developed MACE, and 456 died. The multivariable-adjusted hazard ratios for MACE and all-cause mortality were significantly higher (2.90 and 2.20, respectively) in the group with three or more comorbidities compared to the group with one or fewer comorbidities.

Conclusion

In non-dailysis CKD patients, the multimorbidity is associated with an increased risk of MACE and all-cause mortality. The accumulation of all types of comorbidities, not just cardiovascular comorbidities, was found to be associated with poor outcomes in CKD patients as their number increased.