Heart failure in a cohort of patients with chronic kidney disease: the GCKD study

PLoS One. 2015 Apr 13;10(4):e0122552. doi: 10.1371/journal.pone.0122552. eCollection 2015.


Background and aims: Chronic kidney disease (CKD) is a risk factor for development and progression of heart failure (HF). CKD and HF share common risk factors, but few data exist on the prevalence, signs and symptoms as well as correlates of HF in populations with CKD of moderate severity. We therefore aimed to examine the prevalence and correlates of HF in the German Chronic Kidney Disease (GCKD) study, a large observational prospective study.

Methods and results: We analyzed data from 5,015 GCKD patients aged 18-74 years with an estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73m² or with an eGFR ≥60 and overt proteinuria (>500 mg/d). We evaluated a definition of HF based on the Gothenburg score, a clinical HF score used in epidemiological studies (Gothenburg HF), and self-reported HF. Factors associated with HF were identified using multivariable adjusted logistic regression. The prevalence of Gothenburg HF was 43% (ranging from 24% in those with eGFR >90 to 59% in those with eGFR<30 ml/min/1.73m2). The corresponding estimate for self-reported HF was 18% (range 5%-24%). Lower eGFR was significantly and independently associated with the Gothenburg definition of HF (p-trend <0.001). Additional significantly associated correlates included older age, female gender, higher BMI, hypertension, diabetes mellitus, valvular heart disease, anemia, sleep apnea, and lower educational status.

Conclusions: The burden of self-reported and Gothenburg HF among patients with CKD is high. The proportion of patients who meet the criteria for Gothenburg HF in a European cohort of patients with moderate CKD is more than twice as high as the prevalence of self-reported HF. However, because of the shared signs, symptoms and medications of HF and CKD, the Gothenburg score cannot be used to reliably define HF in CKD patients. Our results emphasize the need for early screening for HF in patients with CKD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Female
  • Glomerular Filtration Rate
  • Heart Failure / diagnosis*
  • Heart Failure / etiology
  • Heart Failure / physiopathology
  • Humans
  • Hypertension / diagnosis*
  • Hypertension / etiology
  • Hypertension / physiopathology
  • Male
  • Middle Aged
  • Prospective Studies
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / physiopathology*
  • Risk Factors

Grants and funding

The GCKD Study is funded by grants from the German Ministry of Education and Research (BMBF) (www.gesundheitsforschung-bmbf.de/de/2101.php; grant number 01ER 0804, 01ER 0818, 01ER 0819, 01ER 0820 und 01ER 0821) and the KfH Foundation for Preventive Medicine (www.kfh-stiftung-praeventivmedizin.de/stiftung.html). AK was funded by the Emmy Noether Programme of the German Research Foundation (DFG KO-3598/2-1). VK and CW were supported by the German Ministry of Education and Research (project 01GL0304: Comprehensive Heart Failure Center). SH was supported by a grant from the Medical Research Foundation at the University of Erlangen-Nürnberg (Forschungsstiftung Medizin). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.