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

作者：Titze Stephanie; Schmid Matthias; Koettgen Anna; Busch Martin; Floege Juergen; Wanner Christoph; Kronenberg Florian; Eckardt Kai Uwe^*

来源：Nephrology Dialysis Transplantation, 2015, 30(3): 441-451.

DOI：10.1093/ndt/gfu294

• cardiovascular disease
• chronic kidney disease
• epidemiology
• nephrology referral

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.
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.
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.
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.

• 出版日期2015-3