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Amdur, Richard L.; Feldman, Harold I.; Gupta, Jayanta; Yang, Wei; Kanetsky, Peter; Shlipak, Michael; Rahman, Mahboob; Lash, James P.; Townsend, Raymond R.; Ojo, Akinlolu; Roy-Chaudhury, Akshay; Go, Alan S.; Joffe, Marshall; He, Jiang; Balakrishnan, Vaidyanathapuram S.; Kimmel, Paul L.; Kusek, John W.; Raj, Dominic S.

Inflammation and Progression of CKD: The CRIC Study

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  • Medientyp: E-Artikel
  • Titel: Inflammation and Progression of CKD: The CRIC Study
  • Beteiligte: Amdur, Richard L.; Feldman, Harold I.; Gupta, Jayanta; Yang, Wei; Kanetsky, Peter; Shlipak, Michael; Rahman, Mahboob; Lash, James P.; Townsend, Raymond R.; Ojo, Akinlolu; Roy-Chaudhury, Akshay; Go, Alan S.; Joffe, Marshall; He, Jiang; Balakrishnan, Vaidyanathapuram S.; Kimmel, Paul L.; Kusek, John W.; Raj, Dominic S.
  • Erschienen: Ovid Technologies (Wolters Kluwer Health), 2016
  • Erschienen in: Clinical Journal of the American Society of Nephrology
  • Sprache: Englisch
  • DOI: 10.2215/cjn.13121215
  • ISSN: 1555-9041; 1555-905X
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:sec> <jats:title>Background and objectives</jats:title> <jats:p>CKD is a global public health problem with significant mortality and morbidity.</jats:p> </jats:sec> <jats:sec> <jats:title>Design, setting, participants, &amp; measurements</jats:title> <jats:p>We examined the multivariable association of plasma levels of IL-1, IL-1 receptor antagonist, IL-6, TNF-<jats:italic toggle="yes">α</jats:italic>, TGF-<jats:italic toggle="yes">β</jats:italic>, high–sensitivity C–reactive protein, fibrinogen, and serum albumin with progression of CKD in 3430 Chronic Renal Insufficiency Cohort study participants.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Over a median follow-up time of 6.3 years, 899 participants reached the composite end point of ≥50% decline in eGFR from baseline or onset of ESRD. Elevated plasma levels of fibrinogen, IL-6, and TNF-<jats:italic toggle="yes">α</jats:italic> and lower serum albumin were associated with a greater decline in eGFR over time. After adjusting for demographics, BP, laboratory variables, medication use, and baseline eGFR, hazard ratios for the composite outcome were greater for the patients in the highest quartile of fibrinogen (hazard ratio, 2.05; 95% confidence interval, 1.64 to 2.55; <jats:italic toggle="yes">P</jats:italic>&lt;0.001), IL-6 (hazard ratio, 1.44; 95% confidence interval, 1.17 to 1.77; <jats:italic toggle="yes">P</jats:italic>&lt;0.01), and TNF-<jats:italic toggle="yes">α</jats:italic> (hazard ratio, 1.94; 95% confidence interval, 1.52 to 2.47; <jats:italic toggle="yes">P</jats:italic>&lt;0.001) compared with those in the respective lowest quartiles. The hazard ratio was 3.48 (95% confidence interval, 2.88 to 4.21; <jats:italic toggle="yes">P</jats:italic>&lt;0.001) for patients in the lowest serum albumin quartile relative to those in the highest quartile. When also adjusted for albuminuria, the associations of fibrinogen (hazard ratio, 1.49; 95% confidence interval, 1.20 to 1.86; <jats:italic toggle="yes">P&lt;</jats:italic>0.001), serum albumin (hazard ratio, 1.52; 95% confidence interval, 1.24 to 1.87; <jats:italic toggle="yes">P</jats:italic>&lt;0.001), and TNF-<jats:italic toggle="yes">α</jats:italic> (hazard ratio, 1.42; 95% confidence interval, 1.11 to 1.81; <jats:italic toggle="yes">P</jats:italic>&lt;0.001) with outcome were attenuated but remained significant.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Elevated plasma levels of fibrinogen and TNF-<jats:italic toggle="yes">α</jats:italic> and decreased serum albumin are associated with rapid loss of kidney function in patients with CKD.</jats:p> </jats:sec>
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