Evidence map›Paper›PMID 32606067›Full record

SynthesisBMJ open2020

Associations between multimorbidity and adverse clinical outcomes in patients with chronic kidney disease: a systematic review and meta-analysis.

Michael K Sullivan, Alastair J Rankin, Bhautesh D Jani, Frances S Mair, Patrick B Mark

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
32citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

32 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Michael K SullivanInstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK michael.sullivan@glasgow.ac.uk.ORCID 0000-0002-3800-2330
Alastair J RankinInstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Bhautesh D JaniGeneral Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Frances S MairGeneral Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Patrick B MarkInstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.

Funding

Medical Research Council MR/V001671/1
6 · The paper itself

Abstract

objectiveTo systematically review the literature exploring the associations between multimorbidity (the presence of two or more long-term conditions (LTCs)) and adverse clinical outcomes in patients with chronic kidney disease (CKD).

designSystematic review and meta-analysis. DATA SOURCES: MEDLINE, EMBASE, CINAHL, Cochrane Library and SCOPUS (1946-2019). The main search terms were 'Chronic Kidney Failure' and 'Multimorbid*'. ELIGIBILITY CRITERIA: Observational studies of adults over the age of 18 with CKD stages 3-5, that is, estimated glomerular filtration rate less than 60 mL/min/1.73 m DATA EXTRACTION AND SYNTHESIS: Newcastle-Ottawa Scale for quality appraisal and risk of bias assessment and fixed effects meta-analysis for data synthesis.

resultsOf 1852 papers identified, 26 met the inclusion criteria. 21 papers involved patients with advanced CKD and no studies were from low or middle-income countries. All-cause mortality was an outcome in all studies. Patients with multimorbidity were at higher risk of mortality compared with patients without multimorbidity (total risk ratio 2.28 (95% CI 1.81 to 2.88)). The risk of mortality was higher with increasing multimorbidity (total HR 1.31 (95% CI 1.27 to 1.36)) and both concordant and discordant LTCs were associated with heightened risk. Multimorbidity was associated with renal progression in four studies, hospitalisation in five studies and cardiovascular events in two studies. LIMITATIONS: Meta-analysis could only include 10 of 26 papers as the methodologies of studies were heterogeneous.

conclusionsThere are associations between multimorbidity and adverse clinical outcomes in patients with CKD. However, most data relate to mortality risk in patients with advanced CKD. There is limited evidence regarding patients with mild to moderate CKD, outcomes such as cardiovascular events, types of LTCs and regarding patients from low or middle-income countries. PROSPERO REGISTRATION NUMBER: CRD42019147424.

Indexed as

Adverse Outcome PathwaysMultimorbidityAdultCardiovascular DiseasesCause of DeathDisease ProgressionGlomerular Filtration RateHospitalizationHumansKidney Failure, ChronicRenal DialysisRisk FactorsSurvival Ratechronic renal failurediabetic nephropathy & vascular diseasedialysisend stage renal failureischaemic heart disease

Identifiers

PMID32606067
PMCPMC7328898

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.