C-Reactive Protein and Risk of ESRD: Results From the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT)

Finnian R. Mc Causland, Brian Claggett, Emmanuel A. Burdmann, Kai Uwe Eckardt, Reshma Kewalramani, Andrew S. Levey, John J V McMurray, Patrick Parfrey, Giuseppe Remuzzi, Ajay K. Singh, Scott D. Solomon, Robert D. Toto, Marc A. Pfeffer

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background To better understand a potential association of elevated C-reactive protein (CRP) level with progression of chronic kidney disease (CKD), we examined the relationship of CRP level with the development of end-stage renal disease (ESRD) in the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT). Study Design Post hoc analysis of a randomized controlled trial. Setting & Participants 4,038 patients with type 2 diabetes, CKD, and anemia in TREAT. Predictor Baseline serum CRP concentrations. Outcomes The primary outcome was development of ESRD; secondary outcomes included doubling of serum creatinine level, a composite of ESRD/serum creatinine doubling, and a composite of death or ESRD. Measurements We fit unadjusted and adjusted Cox regression models to test the association of baseline CRP level with time to the development of the outcomes of interest. Results Mean age of participants was 67 years, 43% were men, and 64% were white. Approximately half (48%) the patients had CRP levels > 3.0 mg/L; 668 patients developed ESRD, and 1,270 developed the composite outcome of death or ESRD. Compared with patients with baseline CRP levels ≤ 3.0 mg/L, those with moderately/markedly elevated CRP levels (≥6.9 mg/L; 24% of patients) had a higher adjusted risk for ESRD (HR, 1.32; 95% CI, 1.07-1.63) and the composite outcome of death or ESRD (HR, 1.41; 95% CI, 1.21-1.64). Although nonsignificant, similar trends were noted in competing-risk models. Limitations Results may not be generalizable to nondiabetic CKD or diabetic CKD in the absence of anemia. Conclusions Elevated baseline CRP levels are common in type 2 diabetic patients with anemia and CKD and are associated with the future development of ESRD and the composite of death or ESRD.

Original languageEnglish
Pages (from-to)873-881
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume68
Issue number6
DOIs
Publication statusPublished - Dec 1 2016

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C-Reactive Protein
Chronic Kidney Failure
Chronic Renal Insufficiency
Therapeutics
Anemia
Creatinine
Darbepoetin alfa
Diabetic Nephropathies
Serum
Proportional Hazards Models
Type 2 Diabetes Mellitus
Blood Proteins
Randomized Controlled Trials

Keywords

  • anemia
  • biomarker
  • C-Reactive protein (CRP)
  • chronic kidney disease (CKD)
  • disease progression
  • end-stage renal disease (ESRD)
  • inflammation
  • kidney function trajectory
  • mortality
  • risk factor
  • serum creatinine
  • type 2 diabetes mellitus (T2DM)

ASJC Scopus subject areas

  • Nephrology

Cite this

Mc Causland, F. R., Claggett, B., Burdmann, E. A., Eckardt, K. U., Kewalramani, R., Levey, A. S., ... Pfeffer, M. A. (2016). C-Reactive Protein and Risk of ESRD: Results From the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT). American Journal of Kidney Diseases, 68(6), 873-881. https://doi.org/10.1053/j.ajkd.2016.07.022

C-Reactive Protein and Risk of ESRD : Results From the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT). / Mc Causland, Finnian R.; Claggett, Brian; Burdmann, Emmanuel A.; Eckardt, Kai Uwe; Kewalramani, Reshma; Levey, Andrew S.; McMurray, John J V; Parfrey, Patrick; Remuzzi, Giuseppe; Singh, Ajay K.; Solomon, Scott D.; Toto, Robert D.; Pfeffer, Marc A.

In: American Journal of Kidney Diseases, Vol. 68, No. 6, 01.12.2016, p. 873-881.

Research output: Contribution to journalArticle

Mc Causland, FR, Claggett, B, Burdmann, EA, Eckardt, KU, Kewalramani, R, Levey, AS, McMurray, JJV, Parfrey, P, Remuzzi, G, Singh, AK, Solomon, SD, Toto, RD & Pfeffer, MA 2016, 'C-Reactive Protein and Risk of ESRD: Results From the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT)', American Journal of Kidney Diseases, vol. 68, no. 6, pp. 873-881. https://doi.org/10.1053/j.ajkd.2016.07.022
Mc Causland, Finnian R. ; Claggett, Brian ; Burdmann, Emmanuel A. ; Eckardt, Kai Uwe ; Kewalramani, Reshma ; Levey, Andrew S. ; McMurray, John J V ; Parfrey, Patrick ; Remuzzi, Giuseppe ; Singh, Ajay K. ; Solomon, Scott D. ; Toto, Robert D. ; Pfeffer, Marc A. / C-Reactive Protein and Risk of ESRD : Results From the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT). In: American Journal of Kidney Diseases. 2016 ; Vol. 68, No. 6. pp. 873-881.
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T2 - Results From the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT)

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AU - Claggett, Brian

AU - Burdmann, Emmanuel A.

AU - Eckardt, Kai Uwe

AU - Kewalramani, Reshma

AU - Levey, Andrew S.

AU - McMurray, John J V

AU - Parfrey, Patrick

AU - Remuzzi, Giuseppe

AU - Singh, Ajay K.

AU - Solomon, Scott D.

AU - Toto, Robert D.

AU - Pfeffer, Marc A.

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N2 - Background To better understand a potential association of elevated C-reactive protein (CRP) level with progression of chronic kidney disease (CKD), we examined the relationship of CRP level with the development of end-stage renal disease (ESRD) in the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT). Study Design Post hoc analysis of a randomized controlled trial. Setting & Participants 4,038 patients with type 2 diabetes, CKD, and anemia in TREAT. Predictor Baseline serum CRP concentrations. Outcomes The primary outcome was development of ESRD; secondary outcomes included doubling of serum creatinine level, a composite of ESRD/serum creatinine doubling, and a composite of death or ESRD. Measurements We fit unadjusted and adjusted Cox regression models to test the association of baseline CRP level with time to the development of the outcomes of interest. Results Mean age of participants was 67 years, 43% were men, and 64% were white. Approximately half (48%) the patients had CRP levels > 3.0 mg/L; 668 patients developed ESRD, and 1,270 developed the composite outcome of death or ESRD. Compared with patients with baseline CRP levels ≤ 3.0 mg/L, those with moderately/markedly elevated CRP levels (≥6.9 mg/L; 24% of patients) had a higher adjusted risk for ESRD (HR, 1.32; 95% CI, 1.07-1.63) and the composite outcome of death or ESRD (HR, 1.41; 95% CI, 1.21-1.64). Although nonsignificant, similar trends were noted in competing-risk models. Limitations Results may not be generalizable to nondiabetic CKD or diabetic CKD in the absence of anemia. Conclusions Elevated baseline CRP levels are common in type 2 diabetic patients with anemia and CKD and are associated with the future development of ESRD and the composite of death or ESRD.

AB - Background To better understand a potential association of elevated C-reactive protein (CRP) level with progression of chronic kidney disease (CKD), we examined the relationship of CRP level with the development of end-stage renal disease (ESRD) in the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT). Study Design Post hoc analysis of a randomized controlled trial. Setting & Participants 4,038 patients with type 2 diabetes, CKD, and anemia in TREAT. Predictor Baseline serum CRP concentrations. Outcomes The primary outcome was development of ESRD; secondary outcomes included doubling of serum creatinine level, a composite of ESRD/serum creatinine doubling, and a composite of death or ESRD. Measurements We fit unadjusted and adjusted Cox regression models to test the association of baseline CRP level with time to the development of the outcomes of interest. Results Mean age of participants was 67 years, 43% were men, and 64% were white. Approximately half (48%) the patients had CRP levels > 3.0 mg/L; 668 patients developed ESRD, and 1,270 developed the composite outcome of death or ESRD. Compared with patients with baseline CRP levels ≤ 3.0 mg/L, those with moderately/markedly elevated CRP levels (≥6.9 mg/L; 24% of patients) had a higher adjusted risk for ESRD (HR, 1.32; 95% CI, 1.07-1.63) and the composite outcome of death or ESRD (HR, 1.41; 95% CI, 1.21-1.64). Although nonsignificant, similar trends were noted in competing-risk models. Limitations Results may not be generalizable to nondiabetic CKD or diabetic CKD in the absence of anemia. Conclusions Elevated baseline CRP levels are common in type 2 diabetic patients with anemia and CKD and are associated with the future development of ESRD and the composite of death or ESRD.

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KW - chronic kidney disease (CKD)

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KW - end-stage renal disease (ESRD)

KW - inflammation

KW - kidney function trajectory

KW - mortality

KW - risk factor

KW - serum creatinine

KW - type 2 diabetes mellitus (T2DM)

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