NDT Advance Access published online on September 3, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp429
Inflammatory biomarkers and decline in kidney function in the elderly: the Cardiovascular Health Study
1 Department of Medicine, University of California San Francisco, San Francisco, CA 2 San Francisco Veterans Affairs Medical Center, General Internal Medicine Section, San Francisco, CA 3 Collaborative Health Studies Coordinating Center, University of Washington, Seattle, WA 4 Division of Nephrology, Tufts-New England Medical Center, Boston, MA 5 Renal Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 6 Division of Nephrology, Veterans Affairs Puget Sound Healthcare System, Seattle, WA 7 Departments of Medicine and Pathology, University of Vermont, Burlington, VT, USA
Correspondence and offprint requests to: Michael G. Shlipak; E-mail: michael.shlipak{at}ucsf.edu
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Abstract |
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Background. Cross-sectional studies have demonstrated a consistent and linear association between circulating inflammatory markers and kidney function. The objective of this study was to determine whether elevated markers of inflammation are independently associated with longitudinal kidney function decline.
Methods. This study included 4128 subjects from the Cardiovascular Health Study. Cystatin C was measured at baseline, 3 years later and 7 years later; eligible subjects had at least two measures. Cystatin C-based estimated glomerular filtration rate (eGFRcysC) was estimated, and rapid kidney function decline was defined as an annual loss of eGFRcysC >3 mL/min/1.73 m2. Predictors included ten inflammatory and procoagulant biomarkers: C-reactive protein, interleukin-6, intercellular adhesion molecule-1, white blood cell count, fibrinogen, factor VII, factor VIII, D-dimer, plasmin-antiplasmin complex and serum albumin.
Results. During the study, 1059 subjects (26%) had a rapid decline in kidney function. In contrast to the other nine inflammatory or procoagulant biomarkers, serum albumin had a consistent and inverse association with rapid kidney function decline [final adjusted logistic regression model: 1.14-fold increased odds (95% CI 1.06–1.23) of rapid decline per standard deviation lower albumin]. The lowest quartile of albumin had an odds ratio of 1.55 (95% CI 1.23–1.96) for rapid decline compared with the highest quartile. These associations persisted after adjusting the albumin models for CRP, IL-6 and fibrinogen.
Conclusions. In contrast to nine other inflammatory and procoagulant markers, only lower baseline levels of serum albumin were consistently associated with a rapid decline in kidney function, as measured by cystatin C-based eGFR.
Keywords: cystatin C; inflammation; inflammatory biomarkers; kidney
Received for publication: 20. 1.09
Accepted in revised form: 31. 7.09