Multimorbidity Patterns of Chronic Kidney Disease and the Risk of COVID-19 Incidence and Mortality in the UK Biobank.

Rationale & Objective: This study explores CKD multimorbidity patterns and their impact on COVID-19 incidence and mortality. Study Design: Observation study. Setting & Participants: 13853 CKD patients diagnosed before January 30, 2020. Exposure: Data on 42 common chronic diseases, SARS-CoV-2 test results, and vaccination status were collected. Outcome(s) COVID-19 incidence and COVID-19 mortality. Analytical Approach: Multiple Correspondence Analysis (MCA) and K-means clustering to identify multimorbidity patterns, and Cox proportional hazards models to analyze their association with COVID-19 incidence and mortality. Results: Of the 13,853 CKD patients, 51.3% were female, with a mean age of 73.2 years. Nearly all (99%) had multiple comorbidities, with hypertension being the most prevalent (81.3%). Cluster analysis identified four specific comorbidity patterns, namely a Cardiovascular Disease Pattern, a Respiratory Disease Pattern,a Psycho-Somatic Disease Pattern,and a Substance or Alcohol Dependence Pattern. Cox model analysis revealed these patterns as significant risk factors for COVID-19 incidence and mortality, compared to Non-specific Disease pattern (which did not exhibit any significant disease). Specifically, Cardiovascular Disease Pattern increased the risk of COVID-19 incidence in CKD patients by 23% (HR 1.23, 95% CI 1.12-1.35) and 275% increased risk of death (3.75, 2.47-5.69) . Additionally, CKD patients with Respiratory Disease Pattern, Psycho-Somatic Disease Pattern, and Substance or Alcohol Dependence Pattern had an increased risk of COVID19 incidence by 33% (1.33, 1.21-1.46), (1.2, 1.07-1.34), and 17% (1.25, 1.01-1.36), respectively; and an increased risk of death by 83% (1.83, 1.09-3.05), 120% (2.2, 1.25-3.88), and 324% (4.24, 2.42-7.45), respectively. Limitations: This study lacked vaccine data for Scottish and Welsh populations, mostly included middle-aged and elderly white UK individuals, limiting generalizability to other racial groups. Conclusion: CKD patients often have complex multimorbidity patterns that significantly influence their susceptibility to COVID-19 and related mortality risks.