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Inflammation and Arterial Stiffness in Chronic Kidney Disease: Findings From the CRIC Study
Eliot Peyster1, Jing Chen2, Harold I Feldman1,3
1Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Insights
In chronic kidney disease (CKD), inflammation is linked to arterial stiffness at one point in time, but it does not predict stiffness progression over four years in a large study.
Area of Science:
- Nephrology
- Cardiology
- Inflammation Research
Background:
- Chronic kidney disease (CKD) is a proinflammatory state linked to cardiovascular risks.
- Arterial stiffness, a predictor of cardiovascular events, is elevated in CKD patients.
- Existing data suggest a cross-sectional association between inflammation and arterial stiffness in CKD, but longitudinal data are lacking.
Purpose of the Study:
- To investigate the relationship between baseline inflammatory markers and the progression of arterial stiffness in a large cohort of CKD patients.
- To determine if inflammation predicts the change in arterial stiffness over a 4-year period in individuals with CKD.
Main Methods:
- Baseline assessment of 5 inflammatory markers and serial measurements of arterial stiffness over 4 years in 3,939 participants of the Chronic Renal Insufficiency Cohort (CRIC) study.
- Cross-sectional and longitudinal analyses were performed, adjusting for potential confounders.
Main Results:
- Cross-sectional analysis revealed significant associations between multiple inflammatory markers (fibrinogen, IL-6, hs-CRP, proteinuria) and arterial stiffness at baseline.
- Longitudinal analysis showed minimal correlation between baseline inflammation levels and changes in arterial stiffness metrics over the 4-year follow-up period.
Conclusions:
- While baseline inflammation is associated with arterial stiffness in CKD patients, it does not appear to predict the progression of arterial stiffness over time.
- Further longitudinal studies are needed to fully understand the complex relationship between chronic inflammation and arterial stiffening in the context of CKD.
Background:
Chronic kidney disease (CKD) and arterial stiffness are associated with increased cardiovascular morbidity and mortality. Inflammation is proposed to have a role in the development of arterial stiffness, and CKD is recognized as a proinflammatory state. Arterial stiffness is increased in CKD, and cross-sectional data has suggested a link between increased inflammatory markers in CKD and higher measures of arterial stiffness. However, no large scale investigations have examined the impact of inflammation on the progression of arterial stiffness in CKD.
Methods:
We performed baseline assessments of 5 inflammatory markers in 3,939 participants from the chronic renal insufficiency cohort (CRIC), along with serial measurements of arterial stiffness at 0, 2, and 4 years of follow-up.
Results:
A total of 2,933 participants completed each of the follow-up stiffness measures. In cross-sectional analysis at enrollment, significant associations with at least 2 measures of stiffness were observed for fibrinogen, interleukin-6, high-sensitivity C-reactive protein, proteinuria, and composite inflammation score after adjustment for confounders. In longitudinal analyses, there were few meaningful correlations between baseline levels of inflammation and changes in metrics of arterial stiffness over time.
Conclusion:
In a large cohort of CKD participants, we observed multiple significant correlations between initial markers of inflammation and metrics of arterial stiffness, but baseline inflammation did not predict changes in arterial stiffness over time. While well-described biologic mechanisms provide the basis for our understanding of the cross-sectional results, continued efforts to design longitudinal studies are necessary to fully elucidate the relationship between chronic inflammation and arterial stiffening.