Comorbidity Patterns Associated with Renal Dysfunction Across COPD Severity Stages and Clinical Phenotypes

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is frequently accompanied by cardiovascular, metabolic, haematological and urinary system comorbidities. The presence of renal dysfunction may further modify the clinical profile and prognostic significance of these comorbid conditions.

Objective: To comparatively evaluate comorbidities associated with renal dysfunction in patients with COPD across different disease severity stages and clinical phenotypes.

Methods: A total of 609 patients with COPD were included in this retrospective study. Patients were analysed according to COPD severity (GOLD stages I–IV) and to the bronchitic, emphysematous and mixed clinical phenotypes. The estimated glomerular filtration rate (eGFR) was calculated with the 2021 CKD-EPI creatinine equation, and renal function was categorised as an eGFR ≤89 versus ≥90 mL/min/1.73 m². The prevalence of ischaemic heart disease, arterial hypertension, diabetes mellitus, anaemia, urinary tract infection and other comorbidities was compared between patients with and without renal dysfunction using Pearson's chi-square test.

Results: Renal dysfunction was significantly associated with COPD severity (χ² = 18.79; p < 0.001). In stage III COPD, anaemia (41.6% vs 22.5%, p < 0.05) and urinary tract infection (53.5% vs 22.5%, p < 0.001) were more frequent in patients with an eGFR ≤89 mL/min/1.73 m². In stage IV, ischaemic heart disease (83.6% vs 72.2%, p < 0.01) and anaemia (42.3% vs 25.2%, p < 0.01) were significantly more prevalent. The bronchitic phenotype showed the greatest number of significant comorbidity associations, whereas in the emphysematous phenotype only ischaemic heart disease differed significantly.

Conclusion: Reduced renal filtration function in COPD is associated with distinct comorbidity patterns depending on disease severity and clinical phenotype. The strongest associations were observed in advanced COPD and in the bronchitic phenotype, supporting integrated assessment of renal function and major comorbidities in these patients.

Keywords:

chronic obstructive pulmonary disease, renal dysfunction, comorbidity, ischaemic heart disease, urinary tract infection, clinical phenotype

References

Dos Santos NC, Miravitlles M, Camelier AA, Almeida VDC, Maciel RRBT, Camelier FWR. Prevalence and impact of comorbidities in individuals with COPD: a systematic review. Tuberc Respir Dis (Seoul). 2022;85(3):205–20. doi:10.4046/trd.2021.0179

Ruan H, Lei S, Zhao H, Zhang H, Zhou X, Li J. Association between comorbidity and chronic obstructive pulmonary disease: a systematic review and meta-analysis of Mendelian randomization studies. Ther Adv Respir Dis. 2025;19:17534666251348393. doi:10.1177/17534666251348393

Liu Z, Ma Z, Ding C. Association between COPD and CKD: a systematic review and meta-analysis. Front Public Health. 2024;12:1494291. doi:10.3389/fpubh.2024.1494291

Pelaia C, Pastori D, Armentaro G, et al. Predictors of renal function worsening in patients with chronic obstructive pulmonary disease (COPD): a multicenter observational study. Nutrients. 2021;13(8):2811. doi:10.3390/nu13082811

Gembillo G, Calimeri S, Tranchida V, et al. Lung dysfunction and chronic kidney disease: a complex network of multiple interactions. J Pers Med. 2023;13(2):286. doi:10.3390/jpm13020286

Chen W, Thomas J, Sadatsafavi M, FitzGerald JM. Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Lancet Respir Med. 2015;3(8):631–9. doi:10.1016/S2213-2600(15)00241-6

Kunitomo Y, Woo H, Balasubramanian A, Fawzy A, Lin CT, Raju S, et al. Longitudinal anemia status and risk for adverse outcomes in former smokers with COPD. Respir Res. 2024;25(1):437. doi:10.1186/s12931-024-03071-y

Garcia-Pachon E, Padilla-Navas I. The impact of anemia on long-term mortality in hospitalized patients with exacerbation of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2024;19:2229–37. doi:10.2147/COPD.S469627

Alisamir M, Ebrahimi M, Rahim F. Anemia in chronic obstructive pulmonary disease: a systematic review. Respir Investig. 2022;60(4):510–21. doi:10.1016/j.resinv.2022.03.006

Figueira-Gonçalves JM, Golpe R, Esteban C, García-Bello MA, Blanco-Cid N, Aramburu A, et al. Evaluation of the multimorbidity network and its relationship with clinical phenotypes in chronic obstructive pulmonary disease: the GALAXIA study. Clin Respir J. 2022;16(7):504–12. doi:10.1111/crj.13518

Dicu-Andreescu I, Penescu MN, Căpușă C, Verzan C. Chronic kidney disease, urinary tract infections and antibiotic nephrotoxicity: are there any relationships? Medicina (Kaunas). 2023;59(1):49. doi:10.3390/medicina59010049