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).

STUDY DESIGN:

Post hoc analysis of a randomized controlled trial.

SETTING & PARTICIPANTS:

4,038 patients with type 2 diabetes, CKD, and anemia in TREAT.

PREDICTOR:

Baseline serum CRP concentrations.

OUTCOMES:

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.

MEASUREMENTS:

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.

LIMITATIONS:

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: Finnian R Mc Causland, Brian Claggett, Emmanuel A Burdmann, Kai-Uwe Eckardt, Reshma Kewalramani, Andrew S Levey, John J V McMurray, Patrick Parfrey, Giuseppe Remuzzi, Ajay K Singh, Scott D Solomon, Robert D Toto, Marc A Pfeffer
• Journal: American journal of kidney diseases : the official journal of the National Kidney Foundation (Am J Kidney Dis) Vol. 68 Issue 6 Pg. 873-881 (Dec 2016) ISSN: 1523-6838 [Electronic] United States
• PMID: 27646425 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Chemical References

• Hematinics
• Darbepoetin alfa
• C-Reactive Protein

Topics

• Aged
• C-Reactive Protein (analysis)
• Cardiovascular Diseases (etiology, prevention & control)
• Darbepoetin alfa (therapeutic use)
• Double-Blind Method
• Female
• Hematinics (therapeutic use)
• Humans
• Kidney Failure, Chronic (blood, complications)
• Male
• Prospective Studies
• Risk Assessment