Dr Jeffrey Ha1,2,3, Luke Buizen1, Dr Hannah Wallace1, Daniel Ketema1, Dr Takaya Sasaki1, Associate Professor Clare Arnott2,4,5, Professor Sunil Badve1,2,6, Dr Juliana de Oliveira Costa7, Associate Professor Michael Falster7, Professor Martin Gallagher1,2, Dr Tamara Milder2,7,8, Professor Sallie-Anne Pearson2,7, Associate Professor Sradha Kotwal1,2, Associate Professor Paul Ronksley9, Professor Mark Woodward10, Associate Professor Brendon Neuen1,2,11, Associate Professor Min Jun1,2
1Renal and Metabolic Division, The George Institute for Global Health, Sydney, Australia, 2Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, Australia, 3Department of Renal Medicine, Wollongong Hospital, Wollongong, Australia, 4Cardiovascular Program, The George Institute for Global Health, Sydney, Australia, 5Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia, 6Department of Renal Medicine, St George Hospital, Sydney, Australia, 7Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, Australia, 8Clinical Diabetes, Appetite and Metabolism Laboratory, Garvan Institute of Medical Research, Sydney, Australia, 9Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada, 10The George Institute for Global Health, School of Public Health, Imperial College London, London, United Kingdom, 11Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia
Biography:
Jeffrey is an academic nephrologist affiliated with Wollongong Hospital, Conjoint Senior Lecturer in the Faculty of Medicine & Health, UNSW Sydney, and postdoctoral research fellow at The George Institute for Global Health. He has global expertise in the management of cardiovascular disease in patients with kidney disease. He is a member of the Australasian Kidney Trials Network CKD Working Group, CARI Guidelines Steering Committee, serves on the Editorial Board of Kidney and Blood Pressure Research, and the committees of 2 international investigator-initiated clinical trials. He is a former editorial intern with the American Journal of Kidney Diseases (2022-2023).
Aim:
Cardiovascular-Kidney-Metabolic (CKM) conditions frequently coexist but estimates of their prevalence are limited to self-reported Australian health surveys. We comprehensively characterise the contemporary prevalence of CKM conditions and the uptake of medicines to treat them.
Methods:
We analysed a national cohort of adults (>18 years) who attended general practices participating in MedicineInsight between January 2011 and December 2020. We assessed annual prevalence of individuals with ≥1 CKM condition (defined as either cardiovascular disease [CVD], chronic kidney disease [CKD], and/or diabetes) over time to 2020, stratified by age (<65 years or ≥65 years) or sex; and prescription of CKM pharmacotherapies in 2020. We ascertained CVD (coronary or peripheral artery disease, heart failure, stroke, or atrial fibrillation), CKD, or diabetes based on comorbidities history or biochemical data.
Results:
In 2020, of 2,641,291 adults, 21.8% had at least one CKM condition, 8.3% had at least 2 CKM conditions, and 1.9% had all three CKM conditions. Between 2011 and 2020, the percentage of adults with ≥1 CKM condition progressively increased (aged ≥65 years: 27.8% to 56.4%; <65 years: 3.1% to 10.1%), and the percentage of adults with three CKM conditions increased from 0.6% to 1.9%. Compared with females, a greater percentage of males had ≥1 CKM condition in 2020 (25.8% vs 18.8%). Among those with three CKM conditions in 2020, 69.5% were prescribed a renin-angiotensin system inhibitor, 78.4% a statin, and only 11.3% and 5.9% were prescribed a sodium-glucose cotransporter-2 inhibitor and glucagon-like peptide-1 receptor agonist, respectively.
Conclusions:
CKM multimorbidity is increasingly common yet considerably undertreated among Australian adults managed in primary care. Implementation strategies are urgently needed to improve uptake of proven therapies in patients with CKM conditions.
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