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Updated: May 22, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Inflammation and coagulation markers and kidney function decline: the Multi-Ethnic Study of Atherosclerosis (MESA)
Jade S Hiramoto1, Ronit Katz, Carmen A Peralta
1Department of Surgery, University of California, San Francisco, CA 94143, USA. jade.hiramoto@ucsfmedctr.org
Insights
Inflammation and coagulation biomarkers, including factor VIII and interleukin 6, are linked to declining kidney function in adults without pre-existing kidney or cardiovascular disease. These findings highlight potential early indicators of kidney health decline.
Area of Science:
- Biomarkers of inflammation and coagulation
- Kidney disease epidemiology
Background:
- The relationship between inflammation, coagulation, and kidney disease progression is not fully understood, particularly in population-based studies.
- Existing research has not definitively established the strength and direction of these associations.
Purpose of the Study:
- To investigate the associations between inflammation and coagulation biomarkers and kidney function decline.
- To identify specific biomarkers that predict kidney function decrease and incident low estimated glomerular filtration rate (eGFR).
Main Methods:
- A prospective observational study involving 4,966 participants from the Multi-Ethnic Study of Atherosclerosis (MESA).
- Participants had an initial eGFR(cys) >60 mL/min/1.73 m(2) and were free of cardiovascular disease.
- Evaluated associations of C-reactive protein (CRP), interleukin 6 (IL-6), fibrinogen, factor VIII, and d-dimer with kidney function decrease over a median follow-up of 4.77 years.
Main Results:
- Higher levels of factor VIII showed the strongest association with kidney function decrease (β = -0.25).
- Interleukin 6 (IL-6) and C-reactive protein (CRP) were also significantly associated with rapid kidney function decrease.
- IL-6 was the only biomarker significantly associated with incident low eGFR.
Conclusions:
- Inflammation and coagulation biomarkers are associated with decreasing kidney function in ambulatory adults.
- These biomarkers may serve as early indicators for kidney function decline in individuals without established kidney or cardiovascular disease.
Background:
The strength and direction of the associations between inflammation and coagulation biomarkers with kidney disease onset and progression remain unclear, especially in a population-based setting.
Study Design:
Prospective observational study.
Setting & Participants:
4,966 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with a cystatin C-based estimate of glomerular filtration rate (eGFR(cys)) >60 mL/min/1.73 m(2) and at least one follow-up measurement of kidney function. All participants were free of cardiovascular disease at entry.
Predictor:
We evaluated the associations of C-reactive protein (CRP), interleukin 6 (IL-6), fibrinogen, factor VIII, and d-dimer levels with kidney function decrease.
Outcomes & Measurements:
Kidney function decrease was assessed primarily by repeated measurements of eGFR(cys) over 5 years. Rapid decrease in kidney function was defined as eGFR decrease >3 mL/min/1.73 m(2) per year. Incident low eGFR was defined as the onset of eGFR(cys) <60 mL/min/1.73 m(2) at any follow-up examination and eGFR(cys) decrease ≥1 mL/min/1.73 m(2) per year.
Results:
Mean age was 60 years, 39% were white, 52% were women, and 11% had diabetes. Mean eGFR(cys) was 96 mL/min/1.73 m(2) and 7% had albuminuria. Median follow-up was 4.77 years. Higher factor VIII levels (per 1 standard deviation [SD] of biomarker) had the strongest association with kidney function decrease (β = -0.25; 95% CI, -0.38 to -0.12; P < 0.001), followed by IL-6 (β = -0.16; 95% CI, -0.29 to -0.03; P = 0.01), CRP (β = -0.09; 95% CI, -0.22 to 0.03; P = 0.1), and fibrinogen levels (β = -0.09; 95% CI, -0.22 to 0.04; P = 0.2). Each 1-SD higher concentration of IL-6 (OR, 1.15; 95% CI, 1.07-1.23), factor VIII (OR, 1.11; 95% CI, 1.03-1.18), and CRP (OR, 1.09; 95% CI, 1.02-1.16) at baseline was associated significantly with rapid kidney function decrease. Only IL-6 level was associated significantly with incident low eGFR (OR, 1.09; 95% CI, 1.00-1.19).
Limitations:
Observational study design and absence of measured GFR.
Conclusions:
Inflammation and coagulation biomarkers are associated with decreasing kidney function in ambulatory adults without established cardiovascular disease or chronic kidney disease.
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