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.
Copyright 2006 S. Karger AG, Basel