Abstract
Inflammation is a pathogenic factor in renal injury, but whether inflammation is related to renal outcome in chronic kidney disease (CKD) patients is little known. We thus assess the association of inflammation and renal outcome in an advanced CKD cohort. This study analyzed the association between inflammatory markers, such as C-reactive protein (hsCRP), white blood cell (WBC) count and ferritin, renal replacement therapy (RRT) and rapid renal progression (estimated GFR slope<-6 ml/min/1.73 m2/y) in 3303 patients with stage 3–5 CKD. In all subjects, the mean hsCRP, WBC count, and ferritin levels were 1.2 (0.4, 5.4) mg/L, 7.2±2.3×103 cells/µL, and 200 (107,349) ng/mL, respectively. During a mean 3.2-year follow-up, there were 1080 (32.7%) subjects commencing RRT, and 841(25.5%) subjects presenting rapid renal progression. Both hsCRP and ferritin were associated with increased risk for RRT with the adjusted HR (tertile 3 versus tertile 1∶1.17 〔1.01–1.36〕 and 1.20 〔1.03–1.40〕, respectively). Both hsCRP and ferritin were associated with increased odds for rapid renal progression with the adjusted OR (tertile 3 versus tertile 1∶1.40 〔1.13–1.77〕 and 1.32 〔1.06–1.67〕, respectively). hsCRP and ferritin stratified by albumin were also associated with RRT and rapid renal progression. Instead, WBC count was not associated with renal outcome. In conclusion, elevated levels of hsCRP and ferritin are risk factors associated with RRT and rapid renal progression in advanced CKD patients.
Highlights
Chronic kidney disease (CKD) has been recognized as a worldwide health threat [1] and understanding its complex pathophysiological mechanisms would help greatly in taking care of patients with CKD
History of cardiovascular disease, mean arterial pressure (MAP), body mass index (BMI), urine protein-creatinine ratio (PCR), serum white blood cell (WBC) count, glycated hemoglobin, ferritin, phosphorus and uric acid levels and stepwise decreases in log urine protein-creatinine ratio (eGFR), serum hemoglobin, albumin, cholesterol, bicarbonate levels corresponded to the advancement from tertile 1 to tertile 3
A number of studies have documented a significant association between inflammation and cardiovascular disease and mortality, and inflammation has been considered as an independent of predictor of adverse outcomes [7,8]
Summary
Chronic kidney disease (CKD) has been recognized as a worldwide health threat [1] and understanding its complex pathophysiological mechanisms would help greatly in taking care of patients with CKD. Inflammation may stimulate glomerular cells to increase production and reduce degradation of extracellular matrix protein, leading to glomerular hypertension, tubulointerstitial fibrosis and renal scarring [6]. Accumulating clinical evidence has demonstrated that inflammation is one of the major causes of poor outcome in patients with renal failure. The increase in CRP has been associated with all-cause and cardiovascular mortality in patients on dialysis or not [7,8,9,10]. White blood cell (WBC) count is a traditional indicator of inflammation and infection responses, and previous studies revealed the significant association of WBC count and adverse outcome in dialysis patients [11]. Ferritin is significantly associated with mortality and cardiovascular outcome in patients with renal failure [13]
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