Study Identifies Prevalence of Cardio-Renal-Metabolic Conditions in US Adults

A poster presented during Kidney Week 2022 examined the characteristics of cardio-renal-metabolic (CRM) conditions and their overlap with each other, as well as the most commonly used treatments.

CRM conditions were defined as cardiovascular disease (CVD), atherosclerotic CVD or heart failure, chronic kidney disease (CKD), or type 2 diabetes (T2D). Dysfunctions in the cardiac, kidney, and metabolic systems are increasingly being recognized as intertwined, requiring multidisciplinary strategies. Shared risk factors for all of these disease include obesity, hypertension, dysglycemia, and dyslipidemia.

Separately, diseases of these 3 systems represent leading causes of death, disability, and economic burden and are prevalent throughout the US population, but the frequency with which they coexist has not been extensively characterized, researchers said.

Researchers used cross-sectional data from the 2015-2018 National Health and Nutrition Examination Survey (NHANES), evaluating nonpregnant US adults aged ≥ 20 years. They calculated weighted proportion of participants with CRM conditions, both overall and stratified by age. They also evaluated the use of CRM drug therapies.

The analysis included an unweighted sample of 9113 US adults (mean age 48.3 years; 51.0% women). Applying population weights, the authors said 27.6% of US adults (about 70 million adults) had ≥ 1 CRM condition, 8.7% had ≥ 2 CRM conditions, and 1.5% had all 3 CRM conditions.

Individually, CVD was seen in 10.1% of participants, CKD in 14.7%, and T2D in 13.1%. CKD and T2D was the most common CRM dyad (3.2%), followed by CVD and CKD (2.1%), and CVD and T2D (1.9%).

By age, of those ≥65 years, 59.1% had ≥1 CRM condition, 24.5% had ≥2, and 4.9% had 3 CRM conditions. In the older age group, CVD and CKD (8.2%) was most common, followed by CKD and T2D (7.4%), and CVD and T2D (4.0%).

Higher CRM comorbidity burden was linked with more severe CKD stage, additive CVD conditions, older age, male sex, Black race, greater prevalence of key CRM risk factors, and poor socioeconomic characteristics.

Among individuals with all 3 CRM conditions, researchers found:

• 66.4% were on statins
• 42.5% were on an angiotensin-converting enzyme inhibitor
• 35.1% were on metformin
• 32.6% were on insulin
• 24.4% were on an angiotensin II receptor blocker
• 8.9% were on a dipeptidyl-4 inhibitor
• 3.0% were on a glucagon-like peptide-2 receptor agonist
• 0.4% were on a sodium-glucose cotransporter 2 inhibitor

The authors noted that the study had several limitations, such as NHANES represents data from individuals living in the community and may not be applicable to other settings. But they called use of CRM therapies “suboptimal.”

The study was funded by Boehringer Ingelheim Pharmaceuticals.

Reference

Ostrominski JW, Arnold SV, Butler J, et al. Prevalence and overlap of cardio-renal-metabolic conditions in US adults, 2015-2018. Presented at: Kidney Week 2022; November 3-6, 2022; Orlando, Florida. Abstract TH-PO601.