期刊
AMERICAN JOURNAL OF KIDNEY DISEASES
卷 73, 期 3, 页码 344-353出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.ajkd.2018.09.012
关键词
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资金
- National Institutes of Health (NIH) [R01 DK073665-01A1, 1U01DK099914-01, 1U01DK099924-01]
- National Institute of Diabetes and Digestive and Kidney Diseases [U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, U01DK060902]
- Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award (CTSA) NIH/National Center for Advancing Translational Sciences (NCATS) [UL1TR000003]
- Johns Hopkins University [UL1 TR-000424]
- University of Maryland General Clinical Research Center [M01 RR-16500]
- Clinical and Translational Science Collaborative of Cleveland
- NCATS component of the NIH [UL1TR000439]
- NIH Roadmap for Medical Research, Michigan Institute for Clinical and Health Research [UL1TR000433]
- University of Illinois at Chicago CTSA [UL1RR029879]
- Tulane COBRE for Clinical and Translational Research in Cardiometabolic Diseases [P20 GM109036]
- Kaiser Permanente NIH/National Center for Research Resources [UCSF-CTSI UL1 RR-024131]
Rationale & Objective: Traditional risk estimates for atherosclerotic vascular disease (ASVD) and death may not perform optimally in the setting of chronic kidney disease (CKD). We sought to determine whether the addition of measures of inflammation and kidney function to traditional estimation tools improves prediction of these events in a diverse cohort of patients with CKD. Study Design: Observational cohort study. Setting & Participants: 2,399 Chronic Renal Insufficiency Cohort (CRIC) Study participants without a history of cardiovascular disease at study entry. Predictors: Baseline plasma levels of biomarkers of inflammation (interleukin 1 beta [IL-1 beta], IL-1 alpha receptor antagonist, IL-6, tumor necrosis factor alpha [TNF-alpha], transforming growth factor beta, high-sensitivity C-reactive protein, fibrinogen, and serum albumin), measures of kidney function (estimated glomerular filtration rate [eGFR] and albuminuria), and the Pooled Cohort Equation probability (PCEP) estimate. Outcomes: Composite of ASVD events (incident myocardial infarction, peripheral arterial disease, and stroke) and death. Analytical Approach: Cox proportional hazard models adjusted for PCEP estimates, albuminuria, and eGFR. Results: During amedian follow-up of 7.3 years, 86, 61, 48, and 323 participants experienced myocardial infarction, peripheral arterial disease, stroke, or death, respectively. The 1-decile greater levels of IL-6 (adjusted HR [aHR], 1.12; 95% CI, 1.08-1.16; P < 0.001), TNF-alpha (aHR, 1.09; 95% CI, 1.05-1.13; P < 0.001), fibrinogen (aHR, 1.07; 95% CI, 1.03-1.11; P < 0.001), and serum albumin (aHR, 0.96; 95% CI, 0.93-0.99; P < 0.002) were independently associated with the composite ASVD-death outcome. A composite inflammation score (CIS) incorporating these 4 biomarkers was associated with a graded increase in risk for the composite outcome. The incidence of ASVD-death increased across the quintiles of risk derived from PCEP, kidney function, and CIS. The addition of eGFR, albuminuria, and CIS to PCEP improved (P = 0.003) the area under the receiver operating characteristic curve for the composite outcome from 0.68 (95% CI, 0.66-0.71) to 0.73 (95% CI, 0.71-0.76). Limitations: Data for cardiovascular death were not available. Conclusions: Biomarkers of inflammation and measures of kidney function are independently associated with incident ASVD events and death in patients with CKD. Traditional cardiovascular risk estimates could be improved by adding markers of inflammation and measures of kidney function.
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