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Dissecting inflammation in ESRD: do cytokines and C-reactive protein have a complementary prognostic value for

Carmine Zoccali1, Giovanni Tripepi, Francesca Mallamaci

  • 1Nephrology, Hypertension & Renal Transplantation Unit, Ospedali Riuniti, Reggio Calabria, Italy. carmine.zoccali@tin.it

Journal of the American Society of Nephrology : JASN
|November 30, 2006
PubMed

Insights

High levels of inflammation biomarkers, including C-reactive protein (CRP) and cytokines, significantly increase mortality risk in ESRD patients. Interleukin-6 (IL-6) alone effectively predicts this increased risk, highlighting its importance in managing inflammation.

Area of Science:

  • Nephrology
  • Immunology
  • Cardiovascular Medicine

Background:

  • Atherogenesis is a chronic inflammatory process involving the immune response.
  • Inflammation plays a critical role in the pathophysiology of End-Stage Renal Disease (ESRD).

Purpose of the Study:

  • To evaluate the predictive power of C-reactive protein (CRP) and proinflammatory cytokines for mortality in ESRD patients.
  • To determine if a combination of inflammation biomarkers offers superior prediction compared to individual markers, particularly IL-6.

Main Methods:

  • A cohort of 217 ESRD patients was followed for an average of 41 months.
  • Mortality risk was analyzed using adjusted models considering inflammation biomarkers (CRP, IL-1 beta, IL-6, IL-18, TNF-alpha).
  • Bayesian receiver operating characteristic (ROC) curve analysis was employed to assess predictive power.

Main Results:

  • Increased levels of one or more inflammation biomarkers were associated with significantly higher relative risks for death (up to 3.05 times).
  • The combined inflammation burden explained 9.1% of mortality variation, marginally more than IL-6 alone (6.1%).
  • Bayesian ROC analysis showed IL-6 alone had identical predictive power (0.59 +/- 0.04) to the combined inflammatory burden.

Conclusions:

  • Interleukin-6 (IL-6) largely captures the predictive power of overall inflammation burden for mortality in ESRD.
  • IL-6 is a highly effective biomarker for assessing the severity of inflammation in ESRD patients.
  • IL-6 is recommended for clinical studies investigating inflammation in ESRD to improve understanding and therapeutic strategies.

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