Abstract
BackgroundWe studied the association of inflammatory biomarkers including C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) with chronic kidney disease (CKD).MethodsWe conducted a case–control study among 201 CKD patients and 201 community-based controls in the greater New Orleans area. CKD was defined as estimated-glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 or albuminuria ≥30 mg/24-h. Serum CRP, TNF-α, and IL-6 were measured using standard methods. Multivariable regression models were used to examine associations between the inflammatory biomarkers and CKD adjusting for important CKD risk factors, history of cardiovascular disease, and use of antihypertensive, antidiabetic, and lipid-lowering agents and aspirin.ResultsThe multivariable-adjusted medians (interquartile-range) were 2.91 (1.47, 5.24) mg/L in patients with CKD vs. 1.91 (0.99, 3.79) mg/L in controls without CKD (p = 0.39 for group difference) for CRP; 1.86 (1.51, 2.63) pg/mL vs. 1.26 (1.01, 1.98) pg/mL (p < 0.0001) for TNF-α; and 2.53 (1.49, 4.42) pg/mL vs. 1.39 (0.95, 2.15) pg/mL (p = 0.04) for IL-6, respectively. Compared to the lowest tertile, the highest tertile of TNF-α (OR 7.1, 95 % CI 3.2 to 15.5) and IL-6 (OR 2.5, 95 % CI 1.1 to 5.5) were significantly associated with higher odds of CKD in multivariable-adjusted models. Additionally, higher TNF-α and IL-6 were independently and significantly associated with lower eGFR and higher albuminuria.ConclusionsOur data suggest that TNF-α and IL-6, but not CRP, are associated with the prevalence and severity of CKD, independent from established CKD risk factors, history of cardiovascular disease, and use of antihypertensive, antidiabetic, and lipid-lowering agents and aspirin.
Highlights
We studied the association of inflammatory biomarkers including C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) with chronic kidney disease (CKD)
Patients with CKD had a mean estimated glomerular filtration rate (eGFR) of 43.4 mL/min/1.73 m2 compared to 96.7 mL/min/1.73 m2 among controls without CKD
Mean Body-mass index (BMI), systolic blood pressure (BP), and serum glucose levels were significantly higher, while LDL- and HDLcholesterol were lower in CKD patients compared to controls
Summary
We studied the association of inflammatory biomarkers including C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) with chronic kidney disease (CKD). C-reactive protein (CRP), an acute phase reactant, is associated with all-cause and CVD mortality in patients with ESRD [3,4,5,6,7]. Tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), key cytokines that mediate both acute and chronic inflammation, are associated with CVD morbidity and mortality in the general population [8,9,10] and in predialysis and dialysis patients [11, 12]. Several epidemiological studies have reported inconsistent findings on the associations of CRP, TNF-α, IL-6, and CKD. Upadhyay and colleagues reported that multivariable-adjusted means of TNF-α and IL-6, but not CRP, were significantly elevated among patients with CKD in the Framingham Offspring
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