title: Heart failure in a cohort of patients with chronic kidney disease: the GCKD study.
abstract: OBJECTIVE
  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.
  
  
  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.
authors: Department of Medicine, Division of Nephrology, Medical Center-University of Freiburg, Freiburg, Germany.
authors: Hanna
authors: H
authors: Beck
authors: Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany.
authors: Stephanie I
authors: SI
authors: Titze
authors: Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany.
authors: Silvia
authors: S
authors: Hübner
authors: Department of Internal Medicine III, University of Jena, Jena, Germany.
authors: Martin
authors: M
authors: Busch
authors: Division of Nephrology and Clinical Immunology, Medical Faculty RWTH Aachen University, Aachen, Germany.
authors: Georg
authors: G
authors: Schlieper
authors: Department of Medicine, Division of Nephrology, Medical Center-University of Freiburg, Freiburg, Germany.
authors: Ulla T
authors: UT
authors: Schultheiss
authors: Department of Internal Medicine I, Division of Nephrology, University of Würzburg, Würzburg, Germany; Comprehensive Heart Failure Centre, University of Würzburg, Würzburg, Germany.
authors: Christoph
authors: C
authors: Wanner
authors: Department of Medical Genetics, Molecular and Clinical Pharmacology, Division of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria.
authors: Florian
authors: F
authors: Kronenberg
authors: Department of Internal Medicine I, Division of Nephrology, University of Würzburg, Würzburg, Germany; Comprehensive Heart Failure Centre, University of Würzburg, Würzburg, Germany.
authors: Vera
authors: V
authors: Krane
authors: Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany.
authors: Kai-Uwe
authors: KU
authors: Eckardt
authors: Department of Medicine, Division of Nephrology, Medical Center-University of Freiburg, Freiburg, Germany.
authors: Anna
authors: A
authors: Köttgen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology*; D012307:Risk Factors