European journal of preventive cardiology · 2026
Low-grade inflammation and cardiovascular events among patients with chronic kidney disease.
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Motiejunaite Justina, Benamara Leïla, Moutard Emilie, Halimi Jean-Michel, Alencar de Pinho Natalia, Danchin Nicolas, Aboyans Victor, Massy Ziad A
Аннотация
AIMS: Chronic inflammation is associated with cardiovascular disease in the general population, but data on patients with chronic kidney disease (CKD) are limited. We sought to assess whether systemic low-grade inflammation is independently associated with cardiovascular events in CKD patients not yet on kidney replacement therapy, with or without a history of atherosclerotic cardiovascular disease (ASCVD).
METHODS: CKD-REIN is a prospective cohort study of adults with CKD stages 2-5, conducted in 40 French nephrology outpatient facilities. Baseline high-sensitivity plasma C-reactive protein (hs-CRP) was centrally measured using an immunoturbidimetric method. Systemic low-grade inflammation was defined as hs-CRP ≥2 mg/L. Cox proportional hazards models estimated cause-specific hazard ratios (HR) and 95% confidence intervals (CI) for major adverse cardiovascular events (MACE; composite of stroke, myocardial infarction, or cardiovascular death) or hospitalization for heart failure (HHF).
RESULTS: We included 2078 patients: 67% men, mean (SD) age 67(13) years, mean eGFR 36(12) mL/min/1.73 m2, 38% with history of ASCVD, median hs-CRP concentration 2.4 mg/L (inter-quartile range 1.1-5.1). After median follow-up of 5 years, 171 patients had a MACE and 207 had HHF. After controlling for potential confounders, a twofold increase in hs-CRP was associated with a 12% (95% CI 0-26) higher cause-specific hazard of MACE and a 26% (95% CI 13-40) higher cause-specific hazard of HHF.
CONCLUSION: In CKD patients not yet on kidney replacement therapy, systemic low-grade inflammation, measured through hs-CRP, is associated with occurrence of cardiovascular events independently of traditional risk factors, including a history of ASCVD.
METHODS: CKD-REIN is a prospective cohort study of adults with CKD stages 2-5, conducted in 40 French nephrology outpatient facilities. Baseline high-sensitivity plasma C-reactive protein (hs-CRP) was centrally measured using an immunoturbidimetric method. Systemic low-grade inflammation was defined as hs-CRP ≥2 mg/L. Cox proportional hazards models estimated cause-specific hazard ratios (HR) and 95% confidence intervals (CI) for major adverse cardiovascular events (MACE; composite of stroke, myocardial infarction, or cardiovascular death) or hospitalization for heart failure (HHF).
RESULTS: We included 2078 patients: 67% men, mean (SD) age 67(13) years, mean eGFR 36(12) mL/min/1.73 m2, 38% with history of ASCVD, median hs-CRP concentration 2.4 mg/L (inter-quartile range 1.1-5.1). After median follow-up of 5 years, 171 patients had a MACE and 207 had HHF. After controlling for potential confounders, a twofold increase in hs-CRP was associated with a 12% (95% CI 0-26) higher cause-specific hazard of MACE and a 26% (95% CI 13-40) higher cause-specific hazard of HHF.
CONCLUSION: In CKD patients not yet on kidney replacement therapy, systemic low-grade inflammation, measured through hs-CRP, is associated with occurrence of cardiovascular events independently of traditional risk factors, including a history of ASCVD.