Heart Failure-Type Symptom Score Trajectories in CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study

Am J Kidney Dis. 2023 Apr;81(4):446-456. doi: 10.1053/j.ajkd.2022.09.016. Epub 2022 Nov 18.


Rationale & objective: Quality of life in chronic kidney disease (CKD) is impaired by a large burden of symptoms including some that overlap with the symptoms of heart failure (HF). We studied a group of individuals with CKD to understand the patterns and trajectories of HF-type symptoms in this setting.

Study design: Prospective cohort study.

Setting & participants: 3,044 participants in the Chronic Renal Insufficiency Cohort (CRIC) without prior diagnosis of HF.

Predictors: Sociodemographics, medical history, medications, vital signs, laboratory values, echocardiographic and electrocardiographic parameters.

Outcome: Trajectory over 5.5 years of a HF-type symptom score (modified Kansas City Cardiomyopathy Questionnaire [KCCQ] Overall Summary Score with a range of 0-100 where<75 reflects clinically significant symptoms).

Analytical approach: Latent class mixed models were used to model trajectories. Multinomial logistic regression was used to model relationships of predictors with trajectory group membership.

Results: Five trajectories of KCCQ score were identified in the cohort of 3,044 adults, 45% of whom were female, and whose median age was 61 years. Group 1 (41.7%) had a stable high score (minimal symptoms, average score of 96); groups 2 (35.6%) and 3 (15.6%) had stable but lower scores (mild symptoms [average of 81] and clinically significant symptoms [average of 52], respectively). Group 4 (4.9%) had a substantial worsening in symptoms over time (mean 31-point decline), and group 5 (2.2%) had a substantial improvement (mean 33-point increase) in KCCQ score. A majority of group 1 was male, without diabetes or obesity, and this group had higher baseline kidney function. A majority of groups 2 and 3 had diabetes and obesity. A majority of group 4 was male and had substantial proteinuria. Group 5 had the highest proportion of baseline cardiovascular disease (CVD).

Limitations: No validation cohort available, CKD management changes in recent years may alter trajectories, and latent class models depend on the missing at random assumption.

Conclusions: Distinct HF-type symptom burden trajectories were identified in the setting of CKD, corresponding to different baseline characteristics. These results highlight the diversity of HF-type symptom experiences in individuals with CKD.

Keywords: CKD progression; Cardiovascular disease (CVD); HF symptoms; chronic kidney disease (CKD); disease prognosis; estimated glomerular filtration rate (eGFR); heart failure (HF); quality of life; renal function; symptom burden; trajectory.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Cohort Studies
  • Diabetes Mellitus*
  • Female
  • Glomerular Filtration Rate
  • Heart Failure* / diagnosis
  • Humans
  • Male
  • Middle Aged
  • Obesity
  • Prospective Studies
  • Quality of Life
  • Renal Insufficiency, Chronic* / diagnosis
  • Vascular Diseases*