Impact of telomere length alteration in chronic kidney disease patients of Pakistan: a case-control study and meta-analysis of 24,089 patients.

BACKGROUND

Chronic kidney disease (CKD) is becoming a global health concern due to its rising prevalence owing to the complex interplay of environmental, genetic, and epigenetic factors. Leukocyte telomere length (LTL) is a potential indicator of biological age in age-related diseases. Our objective is to investigate the association between LTL and CKD in Pakistani population to systematically synthesize existing evidence by investigating previously reported studies.

MATERIAL AND

METHODS

We conducted a case-control study (n = 166), aged 18-60 years. Relative LTL was measured using quantitative real-time PCR and expressed as telomere-to-single copy gene (T/S) ratios. Biochemical parameters and estimated glomerular filtration rate (eGFR) were assessed using standard methods. Multivariable linear regression adjusted for demographic and cardiometabolic factors was performed. A meta-analysis (11 studies, n = 24,089) were conducted.

RESULTS

Our results revealed significant LTL attrition in CKD patients compared to controls with a moderate effect size. Correlational analysis revealed that LTL positively correlated with eGFR (p-value = 0.038) and negatively correlated with urea and creatinine (p < 0.05). After adjustment for age, sex, body mass index, diabetes, smoking, hypertension, and LDL cholesterol, CKD status remained independently associated with shorter LTL. Meta-analysis demonstrated an overall trend toward shorter telomeres in CKD, although substantial heterogeneity and evidence of small study effects were observed. Subgroup analysis in Asian populations showed a consistent but less robust association.

CONCLUSION

LTL is associated with CKD, which may reflect systemic biological aging and disease burden rather than serving as a standalone clinical biomarker. Longitudinal studies are required to clarify causality and population-specific effects.