title: C-Reactive Protein and Risk of ESRD: Results From the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT).
abstract: BACKGROUND
  To better understand a potential association of elevated C-reactive protein (CRP) level with progression of chronic kidney disease (CKD), we examined the relationship of CRP level with the development of end-stage renal disease (ESRD) in the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT).
  
  
  METHODS
  Post hoc analysis of a randomized controlled trial.
  
  
  METHODS
  4,038 patients with type 2 diabetes, CKD, and anemia in TREAT.
  
  
  METHODS
  Baseline serum CRP concentrations.
  
  
  RESULTS
  The primary outcome was development of ESRD; secondary outcomes included doubling of serum creatinine level, a composite of ESRD/serum creatinine doubling, and a composite of death or ESRD.
  
  
  METHODS
  We fit unadjusted and adjusted Cox regression models to test the association of baseline CRP level with time to the development of the outcomes of interest.
  
  
  RESULTS
  Mean age of participants was 67 years, 43% were men, and 64% were white. Approximately half (48%) the patients had CRP levels > 3.0mg/L; 668 patients developed ESRD, and 1,270 developed the composite outcome of death or ESRD. Compared with patients with baseline CRP levels ≤ 3.0mg/L, those with moderately/markedly elevated CRP levels (≥6.9mg/L; 24% of patients) had a higher adjusted risk for ESRD (HR, 1.32; 95% CI, 1.07-1.63) and the composite outcome of death or ESRD (HR, 1.41; 95% CI, 1.21-1.64). Although nonsignificant, similar trends were noted in competing-risk models.
  
  
  CONCLUSIONS
  Results may not be generalizable to nondiabetic CKD or diabetic CKD in the absence of anemia.
  
  
  CONCLUSIONS
  Elevated baseline CRP levels are common in type 2 diabetic patients with anemia and CKD and are associated with the future development of ESRD and the composite of death or ESRD.
authors.affiliation: Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: fmccausland@partners.org.
authors.forename: Finnian R
authors.initials: FR
authors.lastname: Mc Causland
authors.affiliation: Harvard Medical School, Boston, MA; Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Brian
authors.initials: B
authors.lastname: Claggett
authors.affiliation: Division of Nephrology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Emmanuel A
authors.initials: EA
authors.lastname: Burdmann
authors.affiliation: Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Kai-Uwe
authors.initials: KU
authors.lastname: Eckardt
authors.affiliation: Global Clinical Development, Amgen, Thousand Oaks, CA.
authors.forename: Reshma
authors.initials: R
authors.lastname: Kewalramani
authors.affiliation: Division of Nephrology, Tufts Medical Center, Boston, MA.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland.
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.affiliation: Health Sciences Centre, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Parfrey
authors.affiliation: IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy; Unit of Nephrology and Dialysis, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Remuzzi
authors.affiliation: Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Singh
authors.affiliation: Harvard Medical School, Boston, MA; Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.affiliation: Renal Division, University of Texas Southwestern, Dallas, TX.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Toto
authors.affiliation: Harvard Medical School, Boston, MA; Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D000068256:Darbepoetin alfa / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications*; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment
chemical_list: D006397:Hematinics; D000068256:Darbepoetin alfa; D002097:C-Reactive Protein
keywords: C-Reactive protein (CRP); anemia; biomarker; chronic kidney disease (CKD); disease progression; end-stage renal disease (ESRD); inflammation; kidney function trajectory; mortality; risk factor; serum creatinine; type 2 diabetes mellitus (T2DM)