title: Association of C-reactive protein, tumor necrosis factor-alpha, and interleukin-6 with chronic kidney disease.
abstract: BACKGROUND
  We studied the association of inflammatory biomarkers including C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) with chronic kidney disease (CKD).
  
  
  METHODS
  We conducted a case-control study among 201 CKD patients and 201 community-based controls in the greater New Orleans area. CKD was defined as estimated-glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) or albuminuria ≥30 mg/24-h. Serum CRP, TNF-α, and IL-6 were measured using standard methods. Multivariable regression models were used to examine associations between the inflammatory biomarkers and CKD adjusting for important CKD risk factors, history of cardiovascular disease, and use of antihypertensive, antidiabetic, and lipid-lowering agents and aspirin.
  
  
  RESULTS
  The multivariable-adjusted medians (interquartile-range) were 2.91 (1.47, 5.24) mg/L in patients with CKD vs. 1.91 (0.99, 3.79) mg/L in controls without CKD (p = 0.39 for group difference) for CRP; 1.86 (1.51, 2.63) pg/mL vs. 1.26 (1.01, 1.98) pg/mL (p < 0.0001) for TNF-α; and 2.53 (1.49, 4.42) pg/mL vs. 1.39 (0.95, 2.15) pg/mL (p = 0.04) for IL-6, respectively. Compared to the lowest tertile, the highest tertile of TNF-α (OR 7.1, 95% CI 3.2 to 15.5) and IL-6 (OR 2.5, 95% CI 1.1 to 5.5) were significantly associated with higher odds of CKD in multivariable-adjusted models. Additionally, higher TNF-α and IL-6 were independently and significantly associated with lower eGFR and higher albuminuria.
  
  
  CONCLUSIONS
  Our data suggest that TNF-α and IL-6, but not CRP, are associated with the prevalence and severity of CKD, independent from established CKD risk factors, history of cardiovascular disease, and use of antihypertensive, antidiabetic, and lipid-lowering agents and aspirin.
authors.affiliation: Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA. blee14@tulane.edu.
authors.forename: Belinda T
authors.initials: BT
authors.lastname: Lee
authors.affiliation: Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA. drfaheemuddin@gmail.com.
authors.forename: Faheemuddin A
authors.initials: FA
authors.lastname: Ahmed
authors.affiliation: Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA. lhamm@tulane.edu.|Hypertension and Renal Center of Excellence, Tulane University School of Medicine, New Orleans, LA, USA. lhamm@tulane.edu.|Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA. lhamm@tulane.edu.
authors.forename: L Lee
authors.initials: LL
authors.lastname: Hamm
authors.affiliation: Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA. fteran@tulane.edu.
authors.forename: Federico J
authors.initials: FJ
authors.lastname: Teran
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. cchen1@tulane.edu.
authors.forename: Chung-Shiuan
authors.initials: CS
authors.lastname: Chen
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. liuyanxi9@gmail.com.
authors.forename: Yanxi
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA. kshah@tulane.edu.
authors.forename: Kamal
authors.initials: K
authors.lastname: Shah
authors.affiliation: Department of Laboratory Medicine, Children's Hospital, Harvard School of Medicine, Boston, MA, USA. Nader.Rifai@childrens.harvard.edu.
authors.forename: Nader
authors.initials: N
authors.lastname: Rifai
authors.affiliation: Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA. vbatuma@tulane.edu.|Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA. vbatuma@tulane.edu.
authors.forename: Vecihi
authors.initials: V
authors.lastname: Batuman
authors.affiliation: Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA. esimon@tulane.edu.|Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA. esimon@tulane.edu.
authors.forename: Eric E
authors.initials: EE
authors.lastname: Simon
authors.affiliation: Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA. jhe@tulane.edu.|Hypertension and Renal Center of Excellence, Tulane University School of Medicine, New Orleans, LA, USA. jhe@tulane.edu.|Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. jhe@tulane.edu.
authors.forename: Jiang
authors.initials: J
authors.lastname: He
authors.affiliation: Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA. jchen@tulane.edu.|Hypertension and Renal Center of Excellence, Tulane University School of Medicine, New Orleans, LA, USA. jchen@tulane.edu.|Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. jchen@tulane.edu.
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007249:Inflammation; D015850:Interleukin-6 / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000503:physiopathology; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D055815:Young Adult
chemical_list: D015415:Biomarkers; C508600:IL6 protein, human; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D003404:Creatinine