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

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


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / physiopathology*
  • Cohort Studies
  • Comorbidity
  • Diabetic Nephropathies / diagnosis*
  • Diabetic Nephropathies / etiology
  • Female
  • Germany
  • Glomerular Filtration Rate
  • Humans
  • Kidney Function Tests
  • Male
  • Middle Aged
  • Prognosis
  • Proteinuria / diagnosis*
  • Proteinuria / etiology
  • Referral and Consultation
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / physiopathology*
  • Risk Factors