title: Impact of comorbidities on mortality in managed care patients with CKD.
abstract: BACKGROUND
  Our previous work showed that patients with chronic kidney disease (CKD) were 10 times more likely to die than progress to end-stage renal disease. This study examines the impact of comorbidities on mortality risk in a cohort with CKD at 3 levels of progression and a sex- and age-matched comparison group.
  
  
  METHODS
  In a historical, prospective, cohort study, we selected electronic medical record data for health maintenance organization (HMO) members with an index and repeated glomerular filtration rate (GFR) in the range of 15 to 90 mL/min/1.73 m(2) (0.25 to 1.50 mL/s/1.73 m(2)) in 1996 who were followed up for at least 54 months or died during this period. These were matched for birth year and sex with HMO members not meeting GFR criteria, but with the same follow-up criteria. Major comorbid chronic conditions also were identified based on International Classification of Diseases, Ninth Revision, diagnostic codes in the electronic medical record. Conditional logistic regression was used to estimate the relative risk for mortality versus comparison subjects as a function of GFR, age, and other chronic conditions.
  
  
  RESULTS
  In the final sample of 19,945 pairs, we found that risk for mortality increases as GFR decreases, but also that both age and other chronic conditions are significant risk factors for mortality.
  
  
  CONCLUSIONS
  Baseline levels of estimated GFR and other major chronic disorders all contributed negatively to survival. The relative impact of these comorbidities was greatest among younger (<60 years) patients with CKD, and their relative effect diminished with age.
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, OR 97227-1110, USA.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Gullion
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Keith
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Nichols
authors.forename: David H
authors.initials: DH
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000401:mortality*; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008875:Middle Aged; D011446:Prospective Studies; D012737:Sex Factors