Associations of Inflammatory and Coagulation Biomarkers with Kidney Injury Across Chronic and Acute Clinical Settings

Inflammation and coagulation are increasingly recognized as interrelated drivers of kidney injury, yet their combined impact across chronic and acute clinical settings remains incompletely characterized. This study examined the association between inflammatory and coagulation biomarkers and renal outcomes in both a general population cohort and a septic shock ICU cohort. This was a secondary analysis of previously collected data from a community-based cohort and an ICU cohort. In the population cohort, 3,678 participants with repeated kidney function measurements were included, and baseline inflammatory (C-reactive protein [CRP], interleukin-6 [IL-6]) and coagulation biomarkers (fibrinogen, Factor VIII, D-dimer) were assessed. Kidney function decline was evaluated over approximately five years using mixed-effects models. In the ICU cohort, 312 patients were analyzed; disseminated intravascular coagulation (DIC) was defined using International Society on Thrombosis and Haemostasis criteria, and acute kidney injury (AKI) was defined according to KDIGO guidelines. Higher baseline IL-6 and Factor VIII levels were independently associated with faster annual eGFR decline. In the ICU cohort, AKI occurred in 68.6% of patients and DIC in 34.6%. DIC was independently associated with severe AKI and need for renal replacement therapy. Admission procalcitonin demonstrated superior discrimination for AKI compared to CRP. These findings highlight thromboinflammation as a shared mechanistic pathway linking chronic kidney disease progression and sepsis-associated acute kidney injury.