Patterns of multimorbidity and in-hospital kidney function decline in older adults: a latent class analysis of three acute-care cohorts
In brief
Cardiorespiratory and kidney disease pattern roughly doubles odds of in-hospital decline
Across three cohorts totaling 6,755 hospitalized adults aged 65 and older, patients with a cardiorespiratory and kidney disease pattern had about 1.7 to 2.2 times the odds of an in-hospital decline in kidney function compared with patients in other disease-pattern groups. Disease counts alone were less consistent predictors, but the observational findings do not show that the pattern causes decline.
- Journal
- Internal and emergency medicine (Q1)
- Published
- 7 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Maria Serena Iuorio, Luca Soraci, Antonio De Vincentis, Pier Mannuccio Mannucci, Alessandro Nobili, Mauro Tettamanti, et al.
- PMID
- 42842198
- DOI
- 10.1007/s11739-026-04527-3
Why clinicians should know about it
- Picked for Internal Medicine (paper of the day, 8 October 2026): Qualitative multimorbidity predicts in‑hospital eGFR decline
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.