Chronic kidney disease in the context of multimorbidity patterns: the role of physical performance : The screening for CKD among older people across Europe (SCOPE) study

Andrea Corsonello, Paolo Fabbietti, Francesc Formiga, Rafael Moreno-Gonzalez, Lisanne Tap, Francesco Mattace-Raso, Regina Roller-Wirnsberger, Gerhard Wirnsberger, Johan Ärnlöv, Axel C Carlsson, Christian Weingart, Ellen Freiberger, Tomasz Kostka, Agnieszka Guligowska, Pedro Gil, Sara Lainez Martinez, Itshak Melzer, Ilan Yehoshua, Fabrizia Lattanzio, SCOPE investigators, Fabrizia Lattanzio, Andrea Corsonello, Silvia Bustacchini, Silvia Bolognini, Paola D'Ascoli, Raffaella Moresi, Giuseppina Di Stefano, Cinzia Giammarchi, Anna Rita Bonfigli, Roberta Galeazzi, Federica Lenci, Stefano Della Bella, Enrico Bordoni, Mauro Provinciali, Robertina Giacconi, Cinzia Giuli, Demetrio Postacchini, Sabrina Garasto, Annalisa Cozza, Francesco Guarasci, Sonia D'Alia, Romano Firmani, Moreno Nacciariti, Mirko Di Rosa, Paolo Fabbietti, Gerhard Hubert Wirnsberger, Regina Elisabeth Roller-Wirnsberger, Carolin Herzog, Sonja Lindner, Francesco Mattace-Raso, Lisanne Tap, Gijsbertus Ziere, Jeannette Goudzwaard, Tomasz Kostka, Agnieszka Guligowska, Łukasz Kroc, Bartłomiej K Sołtysik, Małgorzata Pigłowska, Agnieszka Wójcik, Zuzanna Chrząstek, Natalia Sosowska, Anna Telążka, Joanna Kostka, Elizaveta Fife, Katarzyna Smyj, Kinga Zel, Rada Artzi-Medvedik, Yehudit Melzer, Mark Clarfield, Itshak Melzer, Ilan Yehoshua, Francesc Formiga, Rafael Moreno-González, Xavier Corbella, Yurema Martínez, Carolina Polo, Josep Maria Cruzado, Pedro Gil Gregorio, Sara Laínez Martínez, Mónica González Alonso, Jose A Herrero Calvo, Fernando Tornero Molina, Lara Guardado Fuentes, Pamela Carrillo García, María Mombiedro Pérez, Alexandra Renz, Susanne Muck, Stephan Theobaldy, Andreas Bekmann, Revekka Kaltsa, Sabine Britting, Robert Kob, Christian Weingart, Ellen Freiberger, Cornel Sieber, Johan Ärnlöv, Axel Carlsson, Tobias Feldreich, Andrea Corsonello, Paolo Fabbietti, Francesc Formiga, Rafael Moreno-Gonzalez, Lisanne Tap, Francesco Mattace-Raso, Regina Roller-Wirnsberger, Gerhard Wirnsberger, Johan Ärnlöv, Axel C Carlsson, Christian Weingart, Ellen Freiberger, Tomasz Kostka, Agnieszka Guligowska, Pedro Gil, Sara Lainez Martinez, Itshak Melzer, Ilan Yehoshua, Fabrizia Lattanzio, SCOPE investigators, Fabrizia Lattanzio, Andrea Corsonello, Silvia Bustacchini, Silvia Bolognini, Paola D'Ascoli, Raffaella Moresi, Giuseppina Di Stefano, Cinzia Giammarchi, Anna Rita Bonfigli, Roberta Galeazzi, Federica Lenci, Stefano Della Bella, Enrico Bordoni, Mauro Provinciali, Robertina Giacconi, Cinzia Giuli, Demetrio Postacchini, Sabrina Garasto, Annalisa Cozza, Francesco Guarasci, Sonia D'Alia, Romano Firmani, Moreno Nacciariti, Mirko Di Rosa, Paolo Fabbietti, Gerhard Hubert Wirnsberger, Regina Elisabeth Roller-Wirnsberger, Carolin Herzog, Sonja Lindner, Francesco Mattace-Raso, Lisanne Tap, Gijsbertus Ziere, Jeannette Goudzwaard, Tomasz Kostka, Agnieszka Guligowska, Łukasz Kroc, Bartłomiej K Sołtysik, Małgorzata Pigłowska, Agnieszka Wójcik, Zuzanna Chrząstek, Natalia Sosowska, Anna Telążka, Joanna Kostka, Elizaveta Fife, Katarzyna Smyj, Kinga Zel, Rada Artzi-Medvedik, Yehudit Melzer, Mark Clarfield, Itshak Melzer, Ilan Yehoshua, Francesc Formiga, Rafael Moreno-González, Xavier Corbella, Yurema Martínez, Carolina Polo, Josep Maria Cruzado, Pedro Gil Gregorio, Sara Laínez Martínez, Mónica González Alonso, Jose A Herrero Calvo, Fernando Tornero Molina, Lara Guardado Fuentes, Pamela Carrillo García, María Mombiedro Pérez, Alexandra Renz, Susanne Muck, Stephan Theobaldy, Andreas Bekmann, Revekka Kaltsa, Sabine Britting, Robert Kob, Christian Weingart, Ellen Freiberger, Cornel Sieber, Johan Ärnlöv, Axel Carlsson, Tobias Feldreich

Abstract

Background: Chronic kidney disease (CKD) is known to be associated with several co-occurring conditions. We aimed at exploring multimorbidity patterns associated with CKD, as well as the impact of physical performance and CKD severity on them in a population of older outpatients.

Methods: Our series consisted of 2252 patients enrolled in the Screening of CKD among Older People across Europe multicenter observational study. Hypertension, stroke, transient ischemic attack, cancer, hip fracture, osteoporosis, Parkinson's disease, asthma, chronic obstructive pulmonary disease, congestive heart failure, angina, myocardial infarction, atrial fibrillation, anemia, CKD (defined as GFR < 60, < 45 or < 30 ml/min/1.73 m2), cognitive impairment, depression, hearing impairment and vision impairment were included in the analyses. Physical performance was assessed by the Short Physical Performance Battery (SPPB) and used as stratification variable. Pairs of co-occurring diseases were analyzed by logistic regression. Patterns of multimorbidity were investigated by hierarchical cluster analysis.

Results: CKD was among the most frequently observed conditions and it was rarely observed without any other co-occurring disease. CKD was significantly associated with hypertension, anemia, heart failure, atrial fibrillation, myocardial infarction and hip fracture. When stratifying by SPPB, CKD was also significantly associated with vision impairment in SPPB = 5-8 group, and hearing impairment in SPPB = 0-4 group. Cluster analysis individuated two main clusters, one including CKD, hypertension and sensory impairments, and the second including all other conditions. Stratifying by SPPB, CKD contribute to a cluster including diabetes, anemia, osteoporosis, hypertension and sensory impairments in the SPPB = 0-4 group. When defining CKD as eGFR< 45 or 30 ml/min/1.73 m2, the strength of the association of CKD with hypertension, sensory impairments, osteoporosis, anemia and CHF increased together with CKD severity in pairs analysis. Severe CKD (eGFR< 30 ml/min/1.73 m2) contributed to a wide cluster including cardiovascular, respiratory and neurologic diseases, as well as osteoporosis, hip fracture and cancer.

Conclusions: CKD and its severity may contribute significantly to specific multimorbidity patterns, at least based on the cluster analysis. Physical performance as assessed by SPPB may be associated with not negligible changes in both co-occurring pairs and multimorbidity clusters.

Trial registration: The SCOPE study is registered at clinicaltrials.gov ( NCT02691546 ).

Keywords: Chronic kidney disease; Multimorbidity; Older; Short physical performance battery.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Dendrograms resulting from clusters analysis testing the distribution and aggregation of chronic diseases in the whole study population and after stratifying by SPPB
Fig. 2
Fig. 2
Dendrograms resulting from clusters analysis testing the distribution and aggregation of chronic diseases in the study population using two different eGFR threshold to define CKD (2)

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