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Exploring systemic inflammation in children with chronic kidney disease: correlates of interleukin 6
Vasiliki Karava1, Antonia Kondou2, John Dotis2
1Pediatric Nephrology Unit, 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642, Thessaloniki, Greece. vasilikikarava@hotmail.fr.
Insights
Systemic inflammation biomarkers, including neutrophil-lymphocyte ratio (NLR), are elevated in pediatric chronic kidney disease (CKD). NLR, serum albumin, and total iron-binding capacity (TIBC) correlate with interleukin-6 (IL-6) levels in pediatric CKD patients.
Area of Science:
- Pediatric Nephrology
- Biomarkers of Inflammation
- Chronic Kidney Disease Research
Background:
- Systemic inflammation (SI) is a known driver of chronic kidney disease (CKD) progression and associated complications.
- Biomarker data for SI in pediatric CKD patients remains limited.
- This study investigates key inflammation and nutritional markers in children with CKD.
Purpose of the Study:
- To investigate the correlation between neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), total iron binding capacity (TIBC), and serum albumin with serum interleukin-6 (IL-6) in pediatric CKD.
- To identify reliable biomarkers for systemic inflammation in pediatric CKD.
- To assess the utility of these markers in predicting elevated IL-6 levels.
Main Methods:
- A case-control and cross-sectional study involving 53 pediatric CKD patients (17 on dialysis) and 25 healthy controls.
- Measurement of NLR, PLR, iron profile, serum albumin, and serum IL-6.
- Statistical analysis to determine correlations and predictive values, with IL-6 levels > 3rd quartile defined as high.
Main Results:
- Pediatric CKD patients, particularly those on dialysis, exhibited significantly higher NLR and PLR compared to controls.
- A significant correlation was found between serum IL-6 and NLR, serum albumin, and TIBC after adjusting for CKD stage.
- A combination of NLR, serum albumin, and TIBC demonstrated good predictive value for high IL-6 levels (AUC 0.771).
Conclusions:
- Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are elevated in pediatric CKD, with higher levels observed in patients undergoing dialysis.
- NLR, in conjunction with TIBC and serum albumin, shows a significant association with IL-6 levels in pediatric CKD.
- These markers offer potential for monitoring systemic inflammation in pediatric CKD patients.
Background:
Systemic inflammation (SI) is linked to chronic kidney disease (CKD) progression and multiple complications. Data regarding SI biomarkers in pediatric patients are scarce. This case-control and cross-sectional study investigates the correlation of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), total iron binding capacity (TIBC) and serum albumin to serum interleukin-6 (IL-6).
Methods:
NLR and PLR were measured in 53 patients (median age: 12.9 years), including 17 on dialysis and 36 with a median glomerular filtration rate of 39 ml/min/1.73m2, and in 25 age and sex-matched healthy controls. Iron profile, serum albumin and IL-6 were measured in the patient group. IL-6 levels > 3rd quartile were classified as high.
Results:
Patients presented higher NLR and PLR and particularly those on dialysis (p < 0.001 and p = 0.001). We observed a significant correlation between natural logarithm (ln) of IL-6 (lnIL-6) and NLR (rs = 0.344, p = 0.014), serum albumin (rs = -0.350, p = 0.011) and TIBC (rs = -0.345, p = 0.012) after adjustment for CKD stage, while the correlation between lnIL-6 and PLR was not significant (rs = 0.206, p = 0.151). Combination of NLR, serum albumin and TIBC predicted high IL-6 (13 patients) with an AUC of 0.771 (95% CI 0.608-0.943). Pairing of NLR ≥ 1.7 and TIBC ≤ 300 μg/dL exhibited the highest sensitivity (76.9%), while incorporating serum albumin ≤ 3.8 g/dL along with them achieved the highest specificity (95%) for detecting high IL-6 levels.
Conclusion:
Both NLR and PLR levels increase in CKD, especially in patients on chronic dialysis. NLR, rather than PLR, along with TIBC and serum albumin, are associated with IL-6 in pediatric CKD.
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