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Inflammation, hemostasis, and the risk of kidney function decline in the Atherosclerosis Risk in Communities (ARIC) Study.

TitleInflammation, hemostasis, and the risk of kidney function decline in the Atherosclerosis Risk in Communities (ARIC) Study.
Publication TypeJournal Article
Year of Publication2009
AuthorsBash LD, Erlinger TP, Coresh J, Marsh-Manzi J, Folsom AR, Astor BC
JournalAm J Kidney Dis
Volume53
Issue4
Pagination596-605
Date Published2009 Apr
ISSN1523-6838
KeywordsBiomarkers, Chronic Disease, Cohort Studies, Creatinine, Disease Progression, Factor VIII, Female, Fibrinogen, Follow-Up Studies, Glomerular Filtration Rate, Hemostasis, Humans, Inflammation, Kidney Diseases, Leukocytes, Male, Middle Aged, Proportional Hazards Models, Prospective Studies, Risk Factors, Serum Albumin, United States, von Willebrand Factor
Abstract

BACKGROUND: Inflammation and hemostasis may increase the risk of kidney function decline; however, data from prospective studies are sparse.

STUDY DESIGN: The Atherosclerosis Risk in Communities (ARIC) Study, a prospective observational cohort.

SETTING & PARTICIPANTS: We used data from 14,854 middle-aged adults from 4 different US communities.

PREDICTOR: Markers of inflammation and hemostasis were examined.

OUTCOMES & MEASUREMENTS: The risk of kidney function decrease associated with these markers was studied. Glomerular filtration rate (GFR) was calculated from serum creatinine levels using the 4-variable Modification of Diet in Renal Disease (MDRD) Study equation. Chronic kidney disease (CKD) was defined as: (1) a decrease in estimated GFR to less than 60 mL/min/1.73 m2 from greater than 60 mL/min/1.73 m2 at baseline, or (2) a hospitalization discharge or death coded for CKD. Serum creatinine was measured at baseline and the 3- and 9-year follow-up visits. Hazard ratios (HRs) of CKD associated with increased levels of inflammatory and hemostatic variables were estimated by using multivariate Cox proportional hazards regression.

RESULTS: 1,787 cases of CKD developed between 1987 and 2004. After adjusting for demographics, smoking, blood pressure, diabetes, lipid levels, prior myocardial infarction, antihypertensive use, alcohol use, year of marker measurement, and baseline renal function using estimated GFR, the risk of incident CKD increased with increasing quartiles of white blood cell count (HR quartile 4 versus quartile 1, 1.30; 95% confidence interval [CI], 1.12 to 1.50; P trend = 0.001), fibrinogen (HR, 1.25; 95% CI, 1.09 to 1.44; P

LIMITATIONS: Although we lacked a direct measure of kidney function, associations were robust to case definitions.

CONCLUSIONS: Markers of inflammation and hemostasis are associated with greater risk of kidney function decrease. Findings suggest that inflammation and hemostasis are antecedent pathways for CKD.

DOI10.1053/j.ajkd.2008.10.044
Alternate JournalAm J Kidney Dis
PubMed ID19110358
PubMed Central IDPMC2778194
Grant ListN01HC55020 / HL / NHLBI NIH HHS / United States
T32 RR023253 / RR / NCRR NIH HHS / United States
T32 HL007024-33 / HL / NHLBI NIH HHS / United States
N01HC55018 / HL / NHLBI NIH HHS / United States
N01-HC-55022 / HC / NHLBI NIH HHS / United States
K23 HL068712-03 / HL / NHLBI NIH HHS / United States
T32 RR023253-02 / RR / NCRR NIH HHS / United States
N01-HC-55016 / HC / NHLBI NIH HHS / United States
5T32-HL-007024-33 / HL / NHLBI NIH HHS / United States
T32 HL007024 / HL / NHLBI NIH HHS / United States
R01 DK076770-02 / DK / NIDDK NIH HHS / United States
N01HC55022 / HL / NHLBI NIH HHS / United States
N01-HC-55021 / HC / NHLBI NIH HHS / United States
N01HC55015 / HL / NHLBI NIH HHS / United States
N01-HC-55019 / HC / NHLBI NIH HHS / United States
N01-HC-55015 / HC / NHLBI NIH HHS / United States
5T32-RR-023253-02 / RR / NCRR NIH HHS / United States
N01-HC-55020 / HC / NHLBI NIH HHS / United States
N01HC55016 / HL / NHLBI NIH HHS / United States
R01 DK076770 / DK / NIDDK NIH HHS / United States
N01HC55019 / HL / NHLBI NIH HHS / United States
N01-HC-55018 / HC / NHLBI NIH HHS / United States
N01HC55021 / HL / NHLBI NIH HHS / United States
5R01-DK-076770-02 / DK / NIDDK NIH HHS / United States