ESKD, Major Cardiovascular Events, and Death Associated With Systemic Inflammation.

Area of Science:

• Nephrology
• Cardiology
• Inflammation

Background:

• Systemic inflammation may influence chronic kidney disease (CKD) progression and major adverse cardiovascular events (MACE).
• The independence of this association from traditional cardiovascular risk factors remains unclear.

Purpose of the Study:

• To compare the incidence of end-stage kidney disease (ESKD), MACE, and death in CKD patients with high-sensitivity C-reactive protein (hsCRP) ≥ 2 mg/l versus hsCRP < 2 mg/l.
• To determine if inflammation is an independent risk factor for adverse outcomes in CKD.

Main Methods:

• Utilized the TRINETX platform to analyze data from 163,854 CKD patients.
• Propensity score matching created comparable groups of 27,580 patients with hsCRP ≥ 2 mg/l and 27,580 patients with hsCRP < 2 mg/l.
• Controlled for traditional cardiovascular risk factors, including blood pressure, LDL cholesterol, eGFR, and albuminuria.

Main Results:

• hsCRP ≥ 2 mg/l was associated with a significantly higher risk of MACE (HR: 1.941) and death (HR: 1.941) compared to hsCRP < 2 mg/l.
• No significant association was found between hsCRP levels and the risk of ESKD (HR: 1.271) in the overall CKD cohort.
• In diabetic CKD patients, hsCRP ≥ 2 mg/l was linked to increased risks of MACE, death, and ESKD (HR: 1.508).

Conclusions:

• Systemic inflammation (hsCRP ≥ 2 mg/l) is independently associated with higher risks of MACE and death in CKD stages 3-4 or albuminuria A3.
• Inflammation also increases ESKD risk in diabetic patients with CKD.
• These findings highlight the importance of managing inflammation in CKD patients, particularly those with diabetes.