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Multimorbidity in people with chronic kidney disease: implications for outcomes and treatment
Simon D S Fraser1, Maarten W Taal
1aAcademic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire SO16 6YD bDivision of Medical Sciences and Graduate-Entry Medicine, University of Nottingham cDepartment of Renal Medicine, Royal Derby Hospital, Derby, UK.
Insights
Multimorbidity is rising in aging populations, particularly with chronic kidney disease (CKD). Understanding comorbidities and their impact on treatment burden is crucial for improving patient care and outcomes.
Area of Science:
- Gerontology
- Nephrology
- Public Health
Background:
- Aging populations are experiencing a rise in multimorbidity.
- Multimorbidity is increasingly prevalent in patients with chronic kidney disease (CKD).
Purpose of the Study:
- To review recent advancements in understanding multimorbidity within CKD.
- To explore the treatment burden and implications of multimorbidity for patient outcomes and care in CKD.
Main Methods:
- Literature review of recent developments in multimorbidity and CKD.
- Analysis of the impact of comorbidities on treatment burden, mortality, cardiovascular disease, and hospitalizations.
- Exploration of factors influencing quality of life and patient capacity for self-management.
Main Results:
- Comorbidity and polypharmacy are prevalent in CKD, increasing treatment burden.
- Both concordant and discordant comorbidities negatively affect mortality, cardiovascular events, and hospital stays.
- Quality of life is significantly impacted by comorbidities and medications beyond CKD.
Conclusions:
- Comorbidities in CKD have substantial implications for patients, clinicians, and healthcare systems.
- Addressing treatment burden and enhancing patient capacity are critical for managing multimorbidity in CKD.
- Further research is needed to identify effective strategies for reducing treatment burden and supporting self-management in elderly CKD patients.
Purpose Of Review:
With ageing populations, the prevalence of multimorbidity is increasing. This review discusses recent developments in the understanding of multimorbidity in the context of chronic kidney disease (CKD). It explores the associated treatment burden and the implications for key outcomes and patient care.
Recent Findings:
Comorbidity and polypharmacy are common in CKD, even at early stages, and are associated with significant treatment burden. Both 'concordant' and 'discordant' comorbidities have a negative impact on mortality, cardiovascular disease, hospitalisation and length of stay. In addition, quality of life is influenced by many factors beyond CKD, including comorbidities and certain medications. Several factors may reduce treatment burden for people with CKD, though research on this is at an early stage. Although patient activation is desirable to support self-management amongst people with multimorbidity, there are significant challenges that impact patient capacity amongst elderly populations with complex needs.
Summary:
Comorbidities are common in CKD and have important implications for patients, clinicians and health services.
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