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Publications

Journal Article Ahead of print

PubMed: 42842198 DOI: 10.1007/s11739-026-04527-3

Patterns of multimorbidity and in-hospital kidney function decline in older adults: a latent class analysis of three acute-care cohorts.

Intern Emerg Med

Authors: Maria Serena Iuorio, Luca Soraci, Antonio De Vincentis, Pier Mannuccio Mannucci, Alessandro Nobili, Mauro Tettamanti, Sara Ratti, Filippo Aucella, Francesco Aucella, Maria Nardella, Mara Volpentesta, Andrea Corsonello, Raffaele Antonelli Incalzi

Affiliations

  • PhD school, Università Campus Bio-Medico di Roma, Rome, Italy.
  • Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), Cda Muoio Piccolo, 87100, Cosenza, Italy.
  • Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Rome, Italy.
  • Research Unit of Internal Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
  • Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy.
  • Department of Health Policy, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, 20156, Milan, Italy.
  • Nephrology and Dialysis Unit, Fondazione Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Foggia, Italy.
  • Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), Cda Muoio Piccolo, 87100, Cosenza, Italy.
  • Department of Pharmacy, Health and Nutritional Sciences, School of Medicine and Digital Technologies, University of Calabria, Arcavacata di Rende, Italy.

Abstract

Multimorbidity is associated with an increased risk of renal function decline in older individuals. In this study, we aimed to evaluate whether multimorbidity patterns differently contributed to this risk in three different hospital settings. We conducted a comparative cohort study of patients aged ≥ 65 years admitted to acute-care hospitals in Italy. Data were drawn from the retrospective SIN-SIGG study (geriatric units, n = 1600; nephrology units, n = 560) and the prospective REPOSI registry (internal medicine units, n = 4595). Quantitative multimorbidity was defined as the number of chronic conditions with prevalence ≥ 5% per cohort; qualitative multimorbidity was derived through latent class analysis of disease combinations. The primary outcome was change in estimated glomerular filtration rate (eGFR) from admission to discharge, calculated using the Berlin Initiative Study 1 (BIS1) equation. A relative decline was defined as ≥ 20% reduction from baseline. Multivariable models were adjusted for age, sex, baseline eGFR, acute diagnoses, and number of medications. Among 6,755 patients (mean age 80.6 years; 47% women), multimorbidity prevalence ranged from 87 to 93%. Quantitative multimorbidity showed modest and inconsistent associations with renal decline. In contrast, qualitative multimorbidity consistently predicted eGFR deterioration. Across all cohorts, the cardiorespiratory and renal cluster was associated with higher odds of in-hospital eGFR decline compared with neurogeriatric and mixed patterns (geriatrics OR 2.24 [95% CI 1.16-4.70]; internal medicine OR 1.72 [95% CI 1.22-2.45]; nephrology OR 2.11 [95% CI 1.01-4.56]). Disease-pattern-based multimorbidity better stratifies short-term renal risk than disease counts, identifying high-risk patients for targeted nephroprotective care during hospitalization.

MeSH

Internal Medicine, Kidney, Nephrology, Prevalence, Multimorbidity, Latent Class Analysis