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Lung and kidney: a dangerous liaison? A population-based cohort study in COPD patients in Italy
Ugo Fedeli1, Alfredo De Giorgi2, Nicola Gennaro1
1Epidemiological Department, Veneto Region.
Insights
Chronic kidney disease (CKD) significantly increases mortality risk in patients with chronic obstructive pulmonary disease (COPD), independent of other health issues. This finding highlights the importance of managing CKD in COPD patients to improve survival rates.
Area of Science:
- Pulmonary Medicine
- Nephrology
- Epidemiology
Background:
- Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality, often accompanied by various comorbid conditions.
- Chronic kidney disease (CKD) is prevalent in older populations and may influence COPD patient outcomes.
- This study investigates the impact of comorbidities, specifically CKD, on mortality in a COPD cohort.
Purpose of the Study:
- To evaluate the relationship between the burden of comorbidities, the presence of CKD, and mortality rates in patients diagnosed with COPD.
- To determine if CKD is an independent risk factor for mortality in COPD patients.
Main Methods:
- A longitudinal cohort study analyzed 27,272 patients discharged with a COPD diagnosis.
- Data on CKD and comorbidities (using the Charlson Comorbidity Index) were extracted from claims data (ICD-9-CM).
- Cox regression analysis assessed the impact of comorbidities on survival, adjusting for COPD severity.
Main Results:
- Less than 40% of COPD patients survived the median 37-month follow-up period.
- CKD was identified as a significant independent risk factor for mortality (HR=1.36, 95% CI 1.30-1.42), even after adjusting for other comorbidities.
- COPD severity, age, and gender were also considered in the analysis.
Conclusions:
- The presence of CKD significantly impacts long-term survival in COPD patients.
- Comorbidities, including CKD, heavily influence mortality outcomes for individuals with COPD.
- Findings underscore the need to consider CKD management in the overall care of COPD patients.
Background:
COPD is among the major causes of death, and it is associated with several comorbid conditions. Chronic kidney disease (CKD) is frequently diagnosed in older people living in Western societies and could impact COPD patients' mortality. We evaluated the relationship between burden of comorbidities, CKD, and mortality in a population-based cohort of patients discharged with a diagnosis of COPD.
Methods:
A longitudinal cohort study was conducted evaluating 27,272 COPD patients. Recruitment of COPD subjects and identification of CKD and other comorbidities summarized by the Charlson comorbidity index (CCI) were based on claims data coded according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). Severity of COPD was classified by hospital diagnosis or exemption from medical charges due to respiratory failure or previous hospitalizations for COPD. The impact of comorbidities on survival was assessed by Cox regression.
Results:
Less than 40% of patients were still alive at the end of a median follow-up of 37 months (17 months for patients who died and 56 months for those alive at the end of follow-up). After adjustment for age, gender, and severity score of COPD, CKD (hazard ratio =1.36, 95% confidence interval 1.30-1.42) independently from comorbidities summarized by the CCI was a significant risk factor for mortality.
Conclusion:
In spite of limitations due to the use of claims data, long-term survival of COPD patients was heavily affected by the presence of CKD and other comorbidities.
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