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Updated: May 22, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Associations between Multimorbidity and the Risks of Cardiovascular Disease Events and All-Cause Mortality in
Kazuhiro Okamura1, Shigeru Tanaka1,2, Hiromasa Kitamura1,2
1Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Insights
Multimorbidity significantly increases cardiovascular event and mortality risks in chronic kidney disease (CKD) patients. Managing multiple conditions is crucial for improving outcomes in this high-risk population.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- Multimorbidity, the presence of multiple chronic conditions, is linked to adverse outcomes and cardiovascular risk in the general population.
- Patients with chronic kidney disease (CKD) face elevated cardiovascular disease (CVD) risk, but the impact of multimorbidity on this group remains unclear.
Purpose of the Study:
- To investigate the association between the number of comorbidities and the risk of major adverse cardiovascular events (MACE) and all-cause mortality in patients with non-dialysis CKD.
Main Methods:
- Analysis of data from 4,420 non-dialysis CKD patients in the Fukuoka Kidney disease Registry Study.
- Identification of 23 comorbidities, categorized into cardiometabolic and non-cardiometabolic conditions.
- Patients grouped by comorbidity count (0-1, 2, 3, ≥4) and analyzed using Cox proportional hazards models for MACE and mortality over 5 years.
Main Results:
- A 5-year follow-up revealed 229 MACE and 456 deaths.
- Increased comorbidity burden correlated with higher MACE risk: adjusted hazard ratios (HRs) for 2, 3, and ≥4 comorbidities were 1.40, 2.27, and 3.53, respectively, compared to 0-1 comorbidity.
- Similarly, all-cause mortality risk escalated with comorbidity count, with adjusted HRs of 1.13, 1.75, and 2.53 for 2, 3, and ≥4 comorbidities, respectively.
Conclusions:
- Multimorbidity is a significant independent risk factor for major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD).
- The presence of multiple comorbidities substantially elevates the risk of all-cause mortality among individuals with CKD.
Introduction:
Multimorbidity, defined as the presence of two or more chronic conditions, is associated with poor outcomes and increased cardiovascular risk in the general population. However, the effect of multimorbidity on patients with chronic kidney disease (CKD), a group of patients already at high risk for cardiovascular disease, is not well understood.
Methods:
We analyzed data from 4,420 patients with non-dialysis CKD enrolled in the Fukuoka Kidney disease Registry Study. We identified 23 comorbidities, including cardiometabolic and non-cardiometabolic conditions. The patients were categorized into four groups according to the number of comorbidities: Group 1 (0-1 comorbidities), Group 2 (2 comorbidities), Group 3 (3 comorbidities), and Group 4 (≥4 comorbidities). We examined the associations between the number of comorbidities and the incidence of major adverse cardiovascular events (MACE) and all-cause mortality using Cox proportional hazards models.
Results:
Over a 5-year follow-up, 229 patients experienced MACE and 456 died. The risk of MACE increased with the number of comorbidities. The multivariable-adjusted hazard ratios (95% confidence intervals) for MACE were 1.40 (0.80-2.44) for Group 2, 2.27 (1.33-3.88) for Group 3, and 3.53 (2.11-5.91) for Group 4 compared with Group 1. The all-cause mortality risk also increased with the number of comorbidities, with adjusted hazard ratios of 1.13 (0.77-1.66), 1.75 (1.22-2.51), and 2.53 (1.80-3.54) for Groups 2, 3, and 4, respectively.
Conclusion:
In patients with CKD, multimorbidity is associated with an increased risk of MACE and all-cause mortality.
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