Inflammation and Arterial Stiffness in Chronic Kidney Disease: Findings From the CRIC Study

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Abstract

<div class="section"> <a class="named-anchor" id="d13258425e405">  </a> <h5 class="section-title" id="d13258425e406">BACKGROUND</h5> <p id="d13258425e408">Chronic kidney disease (CKD) and arterial stiffness are associated with increased cardiovascular morbidity and mortality. Inflammation is proposed to have a role in the development of arterial stiffness, and CKD is recognized as a proinflammatory state. Arterial stiffness is increased in CKD, and cross-sectional data has suggested a link between increased inflammatory markers in CKD and higher measures of arterial stiffness. However, no large scale investigations have examined the impact of inflammation on the progression of arterial stiffness in CKD. </p> </div><div class="section"> <a class="named-anchor" id="d13258425e410">  </a> <h5 class="section-title" id="d13258425e411">METHODS</h5> <p id="d13258425e413">We performed baseline assessments of 5 inflammatory markers in 3,939 participants from the chronic renal insufficiency cohort (CRIC), along with serial measurements of arterial stiffness at 0, 2, and 4 years of follow-up. </p> </div><div class="section"> <a class="named-anchor" id="d13258425e415">  </a> <h5 class="section-title" id="d13258425e416">RESULTS</h5> <p id="d13258425e418">A total of 2,933 participants completed each of the follow-up stiffness measures. In cross-sectional analysis at enrollment, significant associations with at least 2 measures of stiffness were observed for fibrinogen, interleukin-6, high-sensitivity C-reactive protein, proteinuria, and composite inflammation score after adjustment for confounders. In longitudinal analyses, there were few meaningful correlations between baseline levels of inflammation and changes in metrics of arterial stiffness over time. </p> </div><div class="section"> <a class="named-anchor" id="d13258425e420">  </a> <h5 class="section-title" id="d13258425e421">CONCLUSION</h5> <p id="d13258425e423">In a large cohort of CKD participants, we observed multiple significant correlations between initial markers of inflammation and metrics of arterial stiffness, but baseline inflammation did not predict changes in arterial stiffness over time. While well-described biologic mechanisms provide the basis for our understanding of the cross-sectional results, continued efforts to design longitudinal studies are necessary to fully elucidate the relationship between chronic inflammation and arterial stiffening. </p> </div>

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Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.

Alan S Go, Glenn Chertow, Dongjie Fan … (2004)

End-stage renal disease substantially increases the risks of death, cardiovascular disease, and use of specialized health care, but the effects of less severe kidney dysfunction on these outcomes are less well defined. We estimated the longitudinal glomerular filtration rate (GFR) among 1,120,295 adults within a large, integrated system of health care delivery in whom serum creatinine had been measured between 1996 and 2000 and who had not undergone dialysis or kidney transplantation. We examined the multivariable association between the estimated GFR and the risks of death, cardiovascular events, and hospitalization. The median follow-up was 2.84 years, the mean age was 52 years, and 55 percent of the group were women. After adjustment, the risk of death increased as the GFR decreased below 60 ml per minute per 1.73 m2 of body-surface area: the adjusted hazard ratio for death was 1.2 with an estimated GFR of 45 to 59 ml per minute per 1.73 m2 (95 percent confidence interval, 1.1 to 1.2), 1.8 with an estimated GFR of 30 to 44 ml per minute per 1.73 m2 (95 percent confidence interval, 1.7 to 1.9), 3.2 with an estimated GFR of 15 to 29 ml per minute per 1.73 m2 (95 percent confidence interval, 3.1 to 3.4), and 5.9 with an estimated GFR of less than 15 ml per minute per 1.73 m2 (95 percent confidence interval, 5.4 to 6.5). The adjusted hazard ratio for cardiovascular events also increased inversely with the estimated GFR: 1.4 (95 percent confidence interval, 1.4 to 1.5), 2.0 (95 percent confidence interval, 1.9 to 2.1), 2.8 (95 percent confidence interval, 2.6 to 2.9), and 3.4 (95 percent confidence interval, 3.1 to 3.8), respectively. The adjusted risk of hospitalization with a reduced estimated GFR followed a similar pattern. An independent, graded association was observed between a reduced estimated GFR and the risk of death, cardiovascular events, and hospitalization in a large, community-based population. These findings highlight the clinical and public health importance of chronic renal insufficiency. Copyright 2004 Massachusetts Medical Society

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Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis.

Charalambos Vlachopoulos, Konstantinos Aznaouridis, Christodoulos Stefanadis (2010)

The purpose of this study was to calculate robust quantitative estimates of the predictive value of aortic pulse wave velocity (PWV) for future cardiovascular (CV) events and all-cause mortality by meta-analyses of longitudinal studies. Arterial stiffness is increasingly recognized as a surrogate end point for CV disease. We performed a meta-analysis of 17 longitudinal studies that evaluated aortic PWV and followed up 15,877 subjects for a mean of 7.7 years. The pooled relative risk (RR) of clinical events increased in a stepwise, linear-like fashion from the first to the third tertile of aortic PWV. The pooled RRs of total CV events, CV mortality, and all-cause mortality were 2.26 (95% confidence interval: 1.89 to 2.70, 14 studies), 2.02 (95% confidence interval: 1.68 to 2.42, 10 studies), and 1.90 (95% confidence interval: 1.61 to 2.24, 11 studies), respectively, for high versus low aortic PWV subjects. For total CV events and CV mortality, the RR was significantly higher in high baseline risk groups (coronary artery disease, renal disease, hypertension) compared with low-risk subjects (general population). An increase in aortic PWV by 1 m/s corresponded to an age-, sex-, and risk factor-adjusted risk increase of 14%, 15%, and 15% in total CV events, CV mortality, and all-cause mortality, respectively. An increase in aortic PWV by 1 SD was associated with respective increases of 47%, 47%, and 42%. Aortic stiffness expressed as aortic PWV is a strong predictor of future CV events and all-cause mortality. The predictive ability of arterial stiffness is higher in subjects with a higher baseline CV risk.

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Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: A Statement for Healthcare Professionals From the Centers for Disease Control and Prevention and the American Heart Association

Thomas A Pearson, George Mensah, R Alexander … (2003)

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Author and article information

Journal

Title: American Journal of Hypertension

Publisher: Oxford University Press (OUP)

ISSN (Print): 0895-7061

ISSN (Electronic): 1941-7225

Publication date Created: April 2017

Publication date Created: April 01 2017

Publication date Created: February 16 2017

Publication date Other: April 2017

Publication date (Print): April 01 2017

Publication date (Electronic): February 16 2017

Volume: 30

Issue: 4

Pages: 400-408

Affiliations

[1 ] Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA

[2 ] Tulane University Schools of Medicine and Public Health and Tropical Medicine, New Orleans, Louisiana, USA

[3 ] Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA

[4 ] Division of Research, Kaiser Permanente of Northern California, Oakland, California, USA

[5 ] Department of Health Sciences, College of Health Professions and Social Work, Florida Gulf Coast University, Fort Myers, Florida, USA

[6 ] Department of Medicine, University of Illinois, Chicago, Illinois, USA

[7 ] Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA

[8 ] Division of Renal Diseases & Hypertension, MFA-George Washington University, Washington, DC, USA

[9 ] Irving Institute for Clinical and Translational Research, Columbia University, New York, New York, USA

Article

DOI: 10.1093/ajh/hpw164

PMC ID: 5861572

PubMed ID: 28391349

SO-VID: 5482ef69-12bd-4bff-bfca-14a8ff2301e9

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Inflammation and Arterial Stiffness in Chronic Kidney Disease: Findings From the CRIC Study

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Most cited references 34

Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.

Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis.

Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: A Statement for Healthcare Professionals From the Centers for Disease Control and Prevention and the American Heart Association

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