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Updated: Jun 6, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Inflammation-based scores predict chronic kidney disease progression in patients with chronic kidney disease and
1Department of Nephrology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Insights
Inflammation scores like the Prognostic Nutritional Index (PNI) can predict chronic kidney disease (CKD) progression in patients with both CKD and chronic heart failure (CHF). Higher PNI scores indicate a greater risk of CKD progression.
Area of Science:
- Nephrology
- Cardiology
- Inflammation Research
Background:
- Inflammation is linked to poor outcomes in chronic kidney disease (CKD) and chronic heart failure (CHF).
- Limited large-scale data exist on the prognostic value of inflammation-based scores in patients with both conditions.
Purpose of the Study:
- To investigate the clinical associations and prognostic implications of inflammation-based scores in patients with CKD and CHF.
- To determine the relationship between inflammation scores and CKD progression in this patient cohort.
Main Methods:
- Retrospective cohort study of 8491 patients with CKD (stages 1-3b) and CHF from the China Renal Data System (CRDS).
- Utilized Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), Prognostic Nutritional Index (PNI), and Prognostic Index (PI).
- Defined CKD progression as a 40% reduction in estimated glomerular filtration rate (eGFR) or progression to end-stage renal disease (ESRD).
Main Results:
- Higher inflammation scores (GPS, mGPS, PNI, PI) were associated with increased CKD progression rates (log-rank test, p < 0.001).
- Multivariable Cox analysis identified GPS (HR 1.40) and PNI (HR 1.54) as significant predictors of CKD progression.
- PNI demonstrated acceptable prognostic value (C-index = 0.757) and consistent association with CKD progression across subgroups.
Conclusions:
- Inflammation-based scores, particularly PNI, may serve as valuable clinical biomarkers for predicting CKD progression.
- PNI offers a useful tool for risk stratification in patients with co-existing CKD and CHF.
Background:
Inflammation is associated with adverse outcomes of chronic kidney disease (CKD) or chronic heart failure (CHF), but few large data exist. We aimed to explore the clinical associations, and prognostic consequences of inflammation-based scores in patients with CKD and CHF.
Methods:
This work was a retrospective cohort study. Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), Prognostic Nutritional Index (PNI) and Prognostic Index (PI), were used to explore its relationship with CKD progression in patients with CKD stage 1-3b and CHF from the China Renal Data System (CRDS). The composite end point of this study was CKD progression which was defined as eGFR reduction of 40% or progression to end stage renal disease (ESRD).
Results:
Of 8491 patients were enrolled. Kaplan-Meier curve showed that compared to the lower inflammation-based scores, the increased scores have a higher rate of CKD progression, whether in GPS, mGPS, PNI or PI (log-rank test, p < 0.001). After considering competing risk events, multivariable Cox hazards analysis revealed that GPS and PNI scores were significantly related to CKD progression [GPS: hazard ratio (HR) 1.40, 95% confidence interval (CI) 1.11-1.76, p = 0.005; PNI: HR 1.54, 95% CI 1.25-1.89, p < 0.001]. PNI showed acceptable prognostic value (C-index = 0.757, 95% CI 0.734-0.78) compared to GPS, mGPS and PI. In subgroup analysis, PNI was consistently related to CKD progression in patients with or without hypertension, DM, MI, VDH and CVD (P for interaction > 0.05).
Conclusions:
Inflammation-based scores, especially PNI may be a useful clinical biomarker for CKD progression in CKD with CHF patients.
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