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Publications

Journal Article Ahead of print

PubMed: 42906920 DOI: 10.1093/eurjpc/zwag538

Low-grade inflammation and cardiovascular events among patients with chronic kidney disease.

Eur J Prev Cardiol

Authors: Justina Motiejunaite, Leïla Benamara, Emilie Moutard, Jean-Michel Halimi, Natalia Alencar de Pinho, Nicolas Danchin, Victor Aboyans, Ziad A Massy

Affiliations

  • Service de Physiologie et Explorations Fonctionnelles, FHU APOLLO, Assistance Publique - Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, 75018 Paris, France.
  • Université Paris Cité, 75006 Paris, France.
  • Centre for Research in Epidemiology and Population Health (CESP), Inserm U1018, Paris-Saclay University, Versailles Saint-Quentin University, Clinical Epidemiology and Pharmaco-epidemiology Team, Villejuif 94800, France.
  • Medical affairs, Novo Nordisk France, 92800, Puteaux, France.
  • Service de Néphrologie-Hypertension, Dialyse, Transplantation rénale, CHU de Tours, 37000 Tours, France.
  • INSERM UMR1327, ISCHEMIA, Université de Tours, 37000 Tours, France.
  • INI-CRCT, ZIP CODE Tours, France.
  • Department of Cardiology, Hôpital Saint Joseph, 75014 Paris, France.
  • Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France; INSERM U1094 & IRD, Limoges University, 87025 Limoges, France.
  • Nephrology Department, Ambroise Paré University Hospital, Boulogne-Billancourt, 92100 Paris, France.
  • Inserm Unit 1018, Team 5, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Hôpital Paul Brousse, Paris Saclay University (UPS) and Versailles Saint-Quentin-en Yvelines University (UVSQ), 94800, Villejuif, France.

Abstract

AIMS

Chronic inflammation is associated with cardiovascular disease in the general population, but data on patients with chronic kidney disease (CKD) are limited. We sought to assess whether systemic low-grade inflammation is independently associated with cardiovascular events in CKD patients not yet on kidney replacement therapy, with or without a history of atherosclerotic cardiovascular disease (ASCVD).

METHODS

CKD-REIN is a prospective cohort study of adults with CKD stages 2-5, conducted in 40 French nephrology outpatient facilities. Baseline high-sensitivity plasma C-reactive protein (hs-CRP) was centrally measured using an immunoturbidimetric method. Systemic low-grade inflammation was defined as hs-CRP ≥2 mg/L. Cox proportional hazards models estimated cause-specific hazard ratios (HR) and 95% confidence intervals (CI) for major adverse cardiovascular events (MACE; composite of stroke, myocardial infarction, or cardiovascular death) or hospitalization for heart failure (HHF).

RESULTS

We included 2078 patients: 67% men, mean (SD) age 67(13) years, mean eGFR 36(12) mL/min/1.73 m2, 38% with history of ASCVD, median hs-CRP concentration 2.4 mg/L (inter-quartile range 1.1-5.1). After median follow-up of 5 years, 171 patients had a MACE and 207 had HHF. After controlling for potential confounders, a twofold increase in hs-CRP was associated with a 12% (95% CI 0-26) higher cause-specific hazard of MACE and a 26% (95% CI 13-40) higher cause-specific hazard of HHF.

CONCLUSION

In CKD patients not yet on kidney replacement therapy, systemic low-grade inflammation, measured through hs-CRP, is associated with occurrence of cardiovascular events independently of traditional risk factors, including a history of ASCVD.

MeSH

Kidney Diseases, Heart Failure, C-Reactive Protein, Cardiovascular Diseases, Cohort Studies, Kidney, Therapeutics, History, Renal Replacement Therapy