Inflammation and Coagulation Markers and Kidney Function Decline: The Multi-Ethnic Study of Atherosclerosis (MESA)
American Journal of Kidney Diseases,  Clinical Article

Hiramoto JS et al. - Inflammation and coagulation biomarkers are associated with decreasing kidney function in ambulatory adults without established cardiovascular disease or chronic kidney disease.

Methods
  • Prospective observational study.
  • 4,966 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with a cystatin C–based estimate of glomerular filtration rate (eGFRcys) >60 mL/min/1.73 m2 and at least one follow-up measurement of kidney function.
  • All participants were free of cardiovascular disease at entry.
  • The authors evaluated the associations of C-reactive protein (CRP), interleukin 6 (IL-6), fibrinogen, factor VIII, and d-dimer levels with kidney function decrease.
  • Kidney function decrease was assessed primarily by repeated measurements of eGFRcys over 5 years.
  • Rapid decrease in kidney function was defined as eGFR decrease >3 mL/min/1.73 m2 per year.
  • Incident low eGFR was defined as the onset of eGFRcys <60 mL/min/1.73 m2 at any follow-up examination and eGFRcys decrease ≥1 mL/min/1.73 m2 per year.

Results
  • Mean age was 60 years, 39% were white, 52% were women, and 11% had diabetes.
  • Mean eGFRcys was 96 mL/min/1.73 m2 and 7% had albuminuria.
  • Median follow-up was 4.77 years.
  • Higher factor VIII levels (per 1 standard deviation [SD] of biomarker) had the strongest association with kidney function decrease (β = -0.25; 95% CI, -0.38 to -0.12; P < 0.001), followed by IL-6 (β = -0.16; 95% CI, -0.29 to -0.03; P = 0.01), CRP (β = -0.09; 95% CI, -0.22 to 0.03; P = 0.1), and fibrinogen levels (β = -0.09; 95% CI, -0.22 to 0.04; P = 0.2).
  • Each 1-SD higher concentration of IL-6 (OR, 1.15; 95% CI, 1.07-1.23), factor VIII (OR, 1.11; 95% CI, 1.03-1.18), and CRP (OR, 1.09; 95% CI, 1.02-1.16) at baseline was associated significantly with rapid kidney function decrease.
  • Only IL-6 level was associated significantly with incident low eGFR (OR, 1.09; 95% CI, 1.00-1.19).

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