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Nephrol Dial Transplant. 2015 Mar;30(3):441-51. doi: 10.1093/ndt/gfu294. Epub 2014 Sep 30.

Disease burden and risk profile in referred patients with moderate chronic kidney disease: composition of the German Chronic Kidney Disease (GCKD) cohort.

Author information

1
Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, FAU, Erlangen, Germany.
2
Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nürnberg, Erlangen, Germany Department of Medical Biometry, Informatics, and Epidemiology, (IMBIE), University of Bonn, Bonn, Germany.
3
Division of Nephrology, University of Freiburg, Freiburg, Germany.
4
Department of Internal Medicine III, University Hospital Jena, Jena, Germany.
5
Department of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany.
6
Division of Nephrology, Department of Medicine, University Hospital of Würzburg, Würzburg, Germany.
7
Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Innsbruck, Austria.

Abstract

BACKGROUND:

A main challenge for targeting chronic kidney disease (CKD) is the heterogeneity of its causes, co-morbidities and outcomes. Patients under nephrological care represent an important reference population, but knowledge about their characteristics is limited.

METHODS:

We enrolled 5217 carefully phenotyped patients with moderate CKD [estimated glomerular filtration rate (eGFR) 30-60 mL/min per 1.73 m(2) or overt proteinuria at higher eGFR] under routine care of nephrologists into the German Chronic Kidney Disease (GCKD) study, thereby establishing the currently worldwide largest CKD cohort.

RESULTS:

The cohort has 60% men, a mean age (±SD) of 60 ± 12 years, a mean eGFR of 47 ± 17 mL/min per 1.73 m(2) and a median (IQR) urinary albumin/creatinine ratio of 51 (9-392) mg/g. Assessment of causes of CKD revealed a high degree of uncertainty, with the leading cause unknown in 20% and frequent suspicion of multifactorial pathogenesis. Thirty-five per cent of patients had diabetes, but only 15% were considered to have diabetic nephropathy. Cardiovascular disease prevalence was high (32%, excluding hypertension); prevalent risk factors included smoking (59% current or former smokers) and obesity (43% with BMI >30). Despite widespread use of anti-hypertensive medication, only 52% of the cohort had an office blood pressure <140/90 mmHg. Family histories for cardiovascular events (39%) and renal disease (28%) suggest familial aggregation.

CONCLUSIONS:

Patients with moderate CKD under specialist care have a high disease burden. Improved diagnostic accuracy, rigorous management of risk factors and unravelling of the genetic predisposition may represent strategies for improving prognosis.

KEYWORDS:

cardiovascular disease; chronic kidney disease; epidemiology; nephrology referral

PMID:
25271006
DOI:
10.1093/ndt/gfu294
[Indexed for MEDLINE]

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