Lili Liu1,2,3,4, Bixia Gao1,2,3,4, Jinwei Wang1,2,3,4, Chao Yang1,2,3,4, Shouling Wu5, Yuntao Wu5, Shuohua Chen6, Qiuyun Li7, Huifen Zhang8, Guodong Wang5, Min Chen1,2,3,4, Ming-Hui Zhao1,2,3,4,9, Luxia Zhang10,11,12,13,14. 1. Renal Division, Department of Medicine, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China. 2. Institute of Nephrology, Peking University, Beijing, China. 3. Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China. 4. Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing, 100034, China. 5. Department of Cardiology, Kailuan General Hospital Affiliated to North China University of Science and Technology, Tangshan, 063000, China. 6. Department of Health Care Center, Kailuan General Hospital Affiliated to North China University of Science and Technology, Tangshan, 063000, China. 7. Department of Endocrinology, Kailuan General Hospital Affiliated to North China University of Science and Technology, Tangshan, 063000, China. 8. Department of Laboratory, Kailuan General Hospital Affiliated to North China University of Science and Technology, Tangshan, 063000, China. 9. Peking-Tsinghua Center for Life Sciences, Beijing, China. 10. Renal Division, Department of Medicine, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China. zhanglx@bjmu.edu.cn. 11. Institute of Nephrology, Peking University, Beijing, China. zhanglx@bjmu.edu.cn. 12. Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China. zhanglx@bjmu.edu.cn. 13. Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing, 100034, China. zhanglx@bjmu.edu.cn. 14. National Institute of Health Data Science at Peking University, Beijing, China. zhanglx@bjmu.edu.cn.
Abstract
BACKGROUND: The association between high-sensitivity C-reactive protein (hs-CRP) and chronic kidney disease remains controversial and long-term longitudinal studies are limited. We aim to investigate the impact of single and persistent elevation of hs-CRP on kidney outcomes. METHODS: Our study was based on a subgroup of patients with hyperglycemia from the Kailuan cohort. Patients were divided into three groups according to two consecutive hs-CRP levels: (1) no elevation (twice hs-CRP < 3 mg/L); (2) single elevation (once hs-CRP ≥ 3 mg/L); (3) persistent elevation (twice hs-CRP ≥ 3 mg/L). Kidney outcomes include kidney function decline (glomerular filtration rate [GFR] decline ≥ 30% within two years or doubling of serum c reatinine or development of end stage kidney disease [ESKD]), development and progression of proteinuria. RESULTS: Regarding the outcomes of kidney function decline, development and progression of proteinuria, we included 18,665, 11,754 and 1710 patients into analyses, respectively. After 5 years of follow-up, the number of incident cases of kidney function decline, development and progression of proteinuria were 1891, 1337 and 171, respectively. Compared to patients with no elevation of hs-CRP levels, those with persistent but not single elevation of hs-CRP were at higher risk of kidney function decline (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.23-1.64) and development of proteinuria (1.49, 1.26-1.76), but not progression of proteinuria. The results were consistent with propensity score analysis. CONCLUSION: Persistent but not single elevation of hs-CRP was independently associated with increased risk of kidney function decline, and development of proteinuria but not progression in patients with impaired fasting glucose or diabetes.
BACKGROUND: The association between high-sensitivity C-reactive protein (hs-CRP) and chronic kidney disease remains controversial and long-term longitudinal studies are limited. We aim to investigate the impact of single and persistent elevation of hs-CRP on kidney outcomes. METHODS: Our study was based on a subgroup of patients with hyperglycemia from the Kailuan cohort. Patients were divided into three groups according to two consecutive hs-CRP levels: (1) no elevation (twice hs-CRP < 3 mg/L); (2) single elevation (once hs-CRP ≥ 3 mg/L); (3) persistent elevation (twice hs-CRP ≥ 3 mg/L). Kidney outcomes include kidney function decline (glomerular filtration rate [GFR] decline ≥ 30% within two years or doubling of serum c reatinine or development of end stage kidney disease [ESKD]), development and progression of proteinuria. RESULTS: Regarding the outcomes of kidney function decline, development and progression of proteinuria, we included 18,665, 11,754 and 1710 patients into analyses, respectively. After 5 years of follow-up, the number of incident cases of kidney function decline, development and progression of proteinuria were 1891, 1337 and 171, respectively. Compared to patients with no elevation of hs-CRP levels, those with persistent but not single elevation of hs-CRP were at higher risk of kidney function decline (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.23-1.64) and development of proteinuria (1.49, 1.26-1.76), but not progression of proteinuria. The results were consistent with propensity score analysis. CONCLUSION: Persistent but not single elevation of hs-CRP was independently associated with increased risk of kidney function decline, and development of proteinuria but not progression in patients with impaired fasting glucose or diabetes.
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