The impact of chronic kidney disease and cardiovascular comorbidity on mortality in a multiethnic population: a retrospective cohort study.
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ABSTRACT: Objective
To assess the impact of chronic kidney disease (CKD) and cardiovascular comorbidity on mortality in a multiethnic primary care population.Design
Retrospective cohort study.Setting
Inner-city primary care trust in West Midlands, UK.Participants
Individuals aged 40 years and older, of South Asian, black or white ethnicity, registered with a general practice and with their kidney function checked within the last 12 months (n=31 254).Outcome measure
All-cause mortality.Results
Reduced estimated glomerular filtration rate, higher albuminuria, older age, white ethnicity (vs South Asian or black ethnicity) and increasing cardiovascular comorbidities were independent determinants of a higher mortality risk. In the multivariate model including comorbidities and kidney function, the HR for mortality for South Asians was 0.697 (95% CI 0.56 to 0.868, p=0.001) and for blacks it was 0.533 (95% CI 0.403 to 0.704, p<0.001) compared to whites.Conclusions
The HR for death is lower for South Asian and black individuals compared to white individuals. This is, in part, independent of age, gender, socioeconomic status, kidney function and comorbidities. Risk of death is higher in individuals with CKD and with a higher cumulative cardiovascular comorbidity.
SUBMITTER: Jesky M
PROVIDER: S-EPMC3855607 | biostudies-literature | 2013 Dec
REPOSITORIES: biostudies-literature
Publications
The impact of chronic kidney disease and cardiovascular comorbidity on mortality in a multiethnic population: a retrospective cohort study.
Jesky Mark M Lambert Amanda A Burden A C Felix AC Cockwell Paul P
BMJ open 20131203 12
<h4>Objective</h4>To assess the impact of chronic kidney disease (CKD) and cardiovascular comorbidity on mortality in a multiethnic primary care population.<h4>Design</h4>Retrospective cohort study.<h4>Setting</h4>Inner-city primary care trust in West Midlands, UK.<h4>Participants</h4>Individuals aged 40 years and older, of South Asian, black or white ethnicity, registered with a general practice and with their kidney function checked within the last 12 months (n=31 254).<h4>Outcome measure</h4> ...[more]
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Project description:BackgroundDyslipidemia is an important and modifiable risk factor for CVD in children with CKD.MethodsIn a cross-sectional study of baseline serum lipid levels in a large prospective cohort study of children with stage 3-5 (predialysis) CKD, frequencies of abnormal lipid levels and types of dyslipidemia were analyzed in the entire cohort and in subpopulations defined by fasting status or by the presence of nephrotic range proteinuria. Associated clinical and laboratory characteristics were determined by multivariable linear regression analysis.ResultsA total of 681 patients aged 12.2 ± 3.3 years with a mean eGFR of 26.9 ± 11.6 ml/min/1.73 m2 were included. Kidney diagnosis was classified as CAKUT in 69%, glomerulopathy in 8.4%, and other disorders in 22.6% of patients. Nephrotic range proteinuria (defined by a urinary albumin/creatinine ratio > 1.1 g/g) was present in 26.9%. Dyslipidemia was found in 71.8%, and high triglyceride (TG) levels were the most common abnormality (54.7%). Fasting status (38.9%) had no effect on dyslipidemia status. Except for a significant increase in TG in more advanced CKD, lipid levels and frequencies of dyslipidemia were not significantly different between CKD stages. Hypertriglyceridemia was associated with younger age, lower eGFR, shorter duration of CKD, higher body mass index (BMI-SDS), lower serum albumin, and higher diastolic blood pressure.ConclusionsDyslipidemia involving all lipid fractions, but mainly TG, is present in the majority of patients with CKD irrespective of CKD stage or fasting status and is significantly associated with other cardiovascular risk factors.
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Project description:ObjectivesNon-cardiovascular comorbidity is common in cardiovascular disease (CVD) populations but its influence on chest pain (CP) and shortness of breath (SOB) symptom-specific physical limitations is unknown. We wanted to test the a priori hypothesis that an unrelated comorbidity would influence symptom-specific physical limitations and to investigate this impact in different severities of CVD.Method and resultsThe study was based on 5426 patients from ten family practices, organised into eight a priori exclusive severity groups: (i) no CVD or osteoarthritis (OA) (reference), (ii) index hypertension, ischaemic heart disease (IHD) and heart failure (HF) without OA, (iii) index OA without CVD and (iv) same CVD groups with comorbid OA. The measure of CP physical limitations was Seattle Angina Questionnaire and for SOB physical limitations was the Kansas City Cardiomyopathy Questionnaire. Adjusted baseline associations between the cohorts and symptom-specific physical limitations were assessed using linear regression methods. In the study population, 1443 (27%) reported CP and 2097 (39%) SOB. CP and SOB physical limitations increased with CVD severity in the index and comorbid groups. Compared with the respective index CVD group, the CP physical limitation scores for comorbid CVD groups with OA were lower by: -14.7 (95% CI -21.5, 7.8) for hypertension, -5.5 (-10.4, -0.7) for IHD and -22.1 (-31.0, -6.7) for HF. For SOB physical limitations, comorbid scores were lower by: -9.2 (-13.8, -4.6) for hypertension, -6.4 (-11.1, -1.8) for IHD and -8.8 (-19.3, 1.65) for HF.ConclusionsCP and SOB are common symptoms, and OA increases the CVD symptom-specific physical limitations additively. Comorbidity interventions need to be developed for CVD specific health outcomes.
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