Multiple long-term conditions

Advancing research in multiple long-term conditions  

People living with multiple long-term conditions (MLTC - including diabetes, cardiovascular diseases, obesity, mental health and their interaction(s) with chronic kidney disease), including people from Black and South Asian communities and those living in areas of socioeconomic deprivation, are at greater risk of chronic kidney disease (CKD) and poorer outcomes. MLTC also place significant pressure on health services: people with one or more long-term conditions account for around 50% of GP appointments, 64% of outpatient appointments and 70% of hospital bed days. 

Major advances in treatment are helping to slow CKD progression, but too many people are still diagnosed late or experience fragmented services that do not reflect the reality of living with multiple conditions. A more holistic, integrated approach to prevention, diagnosis and care could improve outcomes for patients while also supporting a more effective and sustainable health system. 

Most adults living with kidney disease also have other conditions, such as cardiovascular disease, diabetes, mental health conditions, and obesity. However, medical research tends to study conditions in isolation. It’s crucial that we improve our understanding of how kidney disease influences and is influenced by common co-existing health issues, and how the underlying disease mechanisms interact. This will lead to more effective treatment and diagnostic approaches, alongside a more streamlined and holistic experience for patients.  

In order to enhance patient outcomes, we need a greater mechanistic understanding of the development (and therefore prevention) of chronic kidney disease in the context of other multiple long-term conditions, particularly diabetic kidney disease pathogenesis, the connection between hypertension and CKD as well as the cross-pathways with overweight/obesity, mental health and liver/cholesterol dysfunction.  

Understanding these processes may highlight opportunities for future biomarker development, allowing enhanced patient stratification and subsequent personalised – and holistic - care. Fundamental to the success of this is addressing inequalities around ethnicity and socioeconomic deprivation to ensure broad representation.