High C-reactive protein levels increase risk for chronic kidney disease hospitalisations in adults of a remote Indigenous Australian community - A prospective cohort study

Arnold, Luke W., Hoy, Wendy E. and Wang, Zhiqiang (2017) High C-reactive protein levels increase risk for chronic kidney disease hospitalisations in adults of a remote Indigenous Australian community - A prospective cohort study. Nephrology, 22 9: 699-705. doi:10.1111/nep.12841


Author Arnold, Luke W.
Hoy, Wendy E.
Wang, Zhiqiang
Title High C-reactive protein levels increase risk for chronic kidney disease hospitalisations in adults of a remote Indigenous Australian community - A prospective cohort study
Journal name Nephrology   Check publisher's open access policy
ISSN 1320-5358
1440-1797
Publication date 2017-09-01
Year available 2016
Sub-type Article (original research)
DOI 10.1111/nep.12841
Open Access Status Not yet assessed
Volume 22
Issue 9
Start page 699
End page 705
Total pages 7
Place of publication Richmond, Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Subject 2727 Nephrology
Abstract Background: Indigenous Australians are significantly burdened by chronic kidney disease (CKD). Elevated levels of C-reactive protein (CRP) have been associated with diabetes and cardiovascular incidence in previous studies. Elevated CRP has been associated with albuminuria and reduced eGFR in cross-sectional studies. This study investigated the long-term predictive association between CRP measured at a baseline exam and the incidence of a CKD-related hospitalization. Methods: Health screening examinations were conducted in individuals of a remote indigenous Australian community between 1992 and 1998. The risk of subsequent CKD hospitalisations, documented through Northern Territory hospital records up to 2010, was estimated with Cox proportional hazard models in people aged over 18 years at the baseline screen and who had albumin-creatinine ratios (ACRs) less than 34g/mol. Results: 546 participants were eligible for our study. Individuals in the highest CRP tertile at baseline had increased levels of traditional cardiovascular risk factors. They also had almost 4 times the risk of a CKD-related hospitalisation compared with participants in the lowest CRP tertile (HR=3.91, 95%CI 1.01-15.20, P=0.049) after adjustment for potential confounding factors. Participants with CRP concentrations greater than 3mg/L had almost 3 times the risk of CKD hospitalisations than those ≤3mg/L (HR=2.84, 95%CI 1.00-8.00, P=0.049). Furthermore, risk of CKD hospitalisations increased 34% per doubling of baseline CRP (HR=1.34, 95%CI 1.04-1.74, P=0.024). Conclusion: In individuals in this remote indigenous community without overt albuminuria at baseline the risk for incident CKD related hospitalisations was predicted by elevated C-reactive protein levels almost a decade earlier. Further research is needed to understand the roles that CRP and systemic inflammation play in CKD risk.
Formatted abstract
Background
Indigenous Australians are significantly burdened by chronic kidney disease (CKD). Elevated levels of C-reactive protein (CRP) have been associated with diabetes and cardiovascular incidence in previous studies. Elevated CRP has been associated with albuminuria and reduced eGFR in cross-section, this study investigated the long term predictive association between CRP measured at a baseline exam and the incidence of a CKD-related hospitalisation.

Methods

Health screening examinations were conducted for individuals of a remote indigenous Australian community between 1992 and 1998. Using Northern Territory hospital records up to 2010, Cox proportional hazard models estimated the risk of CKD hospitalisations.

Results
546 participants were included in the analysis and represented 80% of the age-eligible population. The baseline characteristics showed increased levels of traditional cardiovascular risk factors in individuals of the highest CRP tertile. Participants in the highest CRP tertile had almost 4 times the risk for a CKD-related hospitalisation compared with participants in the lowest tertile (HR = 3.91, 95%CI 1.01-15.20, p = 0.049) after adjustment for potential confounding factors. Participants with CRP concentrations greater than 3 mg/L had almost 3 times the risk of CKD hospitalisations than those ≤3 mg/L (HR = 2.84, 95%CI 1.00-8.00, p = 0.049). Furthermore, risk for CKD increased 34% per doubled increase in CRP (HR = 1.34, 95%CI 1.04-1.74, p = 0.024).

Conclusions
Elevated C-reactive protein levels can predict the risk for CKD almost a decade prior to an incident CKD-related hospitalisation in individuals of this remote indigenous community. Further research is needed to understand the role CRP and systemic inflammation plays in CKD risk.
Keyword Urology & Nephrology
Urology & Nephrology
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
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Created: Tue, 21 Jun 2016, 19:55:27 EST by Zhiqiang Wang on behalf of Medicine - Royal Brisbane and Women's Hospital