Kidney Week

Abstract: SA-PO785

Inflammatory Markers and Incidence of Hospitalization with Infection in CKD: The Chronic Renal Insufficiency Cohort Study

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - III
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Ishigami, Junichi, Johns Hopkins School of Public Health, Baltimore, Maryland, United States

Junichi Ishigami,

• Taliercio, Jonathan J., Glickman Urological and Kidney Institute, Cleveland, Ohio, United States

Jonathan J. Taliercio,

• Feldman, Harold I., University of Pennsylvania, Philadelphia, Pennsylvania, United States

Harold I. Feldman,

• Srivastava, Anand, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Anand Srivastava,

• Townsend, Raymond R., University of Pennsylvania School of Medicine, Villanova, Pennsylvania, United States

Raymond R. Townsend,

• Cohen, Debbie L., University of Pennsylvania School of Medicine, Villanova, Pennsylvania, United States

Debbie L. Cohen,

• Rao, Panduranga S., University of Michigan Health System, Ann Arbor, Michigan, United States

Panduranga S. Rao,

• Fink, Jeffrey C., University of Maryland, Baltimore, Maryland, United States

Jeffrey C. Fink,

• Ricardo, Ana C., University of Illinois at Chicago, Chicago, Illinois, United States

Ana C. Ricardo,

• Chen, Teresa K., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Teresa K. Chen,

• Wolf, Myles, Duke University, Durham, North Carolina, United States

Myles Wolf,

• Isakova, Tamara, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States

Tamara Isakova,

• Charleston, Jeanne, Johns Hopkins University, Baltimore, Maryland, United States

Jeanne Charleston,

• Sondheimer, James H., Wayne State University School of Medicine, Detroit, Michigan, United States

James H. Sondheimer,

• Horwitz, Edward J., MetroHealth, Cleveland, Ohio, United States

Edward J. Horwitz,

• Appel, Lawrence J., Johns Hopkins Medical Institutions, Baltimore, Maryland, United States

Lawrence J. Appel,

• Matsushita, Kunihiro, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States

Kunihiro Matsushita,

Background

Low grade inflammation may be linked to the impaired immune response in CKD. Whether inflammatory markers are associated with risk of hospitalization with infection is unknown.

Methods

In 3,622 participants of the CRIC Study, we assessed the association between the baseline levels of four inflammatory markers (interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α], interleukin-1 receptor antagonist [IL-1RA], and transforming growth factor-β [TGF-β]) and incidence of hospitalization with major infections (pneumonia, urinary tract infections, cellulitis and osteomyelitis, and bloodstream infections) using Cox models adjusted for potential confounders including eGFR and uACR to estimate hazard ratio (HR). The inflammatory markers were log-transformed and modeled as restricted cubic spline with the knots at 5^th, 50^th, and 95^th percentile.

Results

During a median follow-up of 7.5 years, 36% (n=1,294) had a hospitalization with major infections. Higher levels of IL-6 and TNF-α, but not IL-1RA or TGF-β, were each monotonically associated with increased risk of hospitalization with infection (Figure) (HR at 95^th vs. 5^th percentile, 2.27 [95%CI, 1.81-2.85] for IL-6 and 1.96 [1.59-2.42] for TNF-α). The associations of IL-6 and TNF-α were independent of each other and consistent across types of infection or in demographic and clinical subgroups.

Conclusion

Higher levels of IL-6 and TNF-α, but not IL1RA or TGF-β, were independently associated with increased risk of hospitalization with infection. Future studies are needed to explore the underlying mechanisms of the discrepant patterns in the association with risk of infection across inflammatory markers.

Figure: Histogram and HRs of hospitalization with infection for (A) IL-6, (B) TNF-α, (C) IL-1RA, and (D) TGF-β. Vertical lines indicate 5^th (reference) and 95^th percentiles.