Positive acute-phase inflammatory markers in different stages of chronic kidney disease.
BACKGROUND
An elevated serum level of acute-phase inflammatory markers is associated with an increased risk of cardiovascular disease. We hypothesized that elevated acute-phase inflammatory markers are directly associated with the different stages of chronic kidney disease (CKD).


METHODS
We evaluated the relationship between serum levels of high-sensitivity C-reactive protein (hsCRP) and alpha1-acid glycoprotein (alpha1-AGP), as well as the renal function in 224 adult patients with CKD (mean age 56.6 years, 46% male, and 40% diabetics), stratified according to the glomerular filtration rate (GFR) (based on the National Kidney Foundation/Kidney Dialysis Outcomes Quality Initiatives), and in 94 hemodialysis patients.


RESULTS
The mean hsCRP was 8.2 +/- 12.1 mg/l, and hsCRP levels were >5 mg/l in 44.4% of the patients; alpha1-AGP levels were >125 mg/dl in 33.3% of the patients. Mean hsCRP and alpha1-AGP were significantly higher in more severe stages of CKD. A weak inverse relationship was found between GFR and serum hsCRP (r = -0.2205; p = 0.0006) and between GFR and serum alpha1-AGP (r = -0.3266; p < 0.0001). There was a correlation between hsCRP and alpha1-AGP (r = 0.3417; p < 0.0001). No significant differences were detected between patients with CKD and those undergoing hemodialysis concerning hsCRP (8.2 +/- 12.1 vs. 6.8 +/- 7.4 mg/l; p = 0.2980) and alpha1-AGP (116.3 +/- 42.5 vs. 117.2 +/- 37.9 mg/dl; p = 0.8590). However, the level of hsCRP was significantly reduced in hemodialysis patients compared with patients with stage 5 predialytic disease (12.1 +/- 13.9 to 6.8 +/- 7.4 mg/l; p = 0.005). More patients with stage 5 predialytic CKD had an elevated hsCRP serum level compared with patients on hemodialysis (64.7 vs. 37.9%; chi2 = 6.230, p < 0.01).


CONCLUSIONS
Approximately 50% of patients with CKD--even in the early phase of renal failure--exhibit an activated acute-phase response, which is closely related to the stages of CKD. Hemodialysis may partially correct the inflammatory process present in the immediate predialysis phase of CKD.
Romão
João Egidio
JE
Nephrology Service, Hospital das Clínicas da FMUSP, São Paulo, Brazil. joao.egidio@uol.com.br
Haiashi
Adlei Rogério
AR
Elias
Rosilene Mota
RM
Luders
Cláudio
C
Ferraboli
Rosiani
R
Castro
Manoel Carlos Martins
MC
Abensur
Hugo
H
D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis*; D002908:Chronic Disease; D003928:Diabetic Nephropathies / Q000097:blood; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009961:Orosomucoid / Q000032:analysis*; D006435:Renal Dialysis; D012720:Severity of Illness Index
D015415:Biomarkers; D009961:Orosomucoid; D002097:C-Reactive Protein