#2108 High-sensitivity C-reactive protein levels and mortality, cardiovascular events, and adverse kidney outcomes in non-dialysis-dependent CKD patients

Abstract Background and Aims Systemic inflammation is a recognized factor in adverse outcomes, yet few studies have explored its impact in patients with non-dialysis-dependent chronic kidney disease (CKD). This study aimed to investigate the association between high-sensitivity C-reactive protein (hs-CRP) levels and all-cause mortality, cardiovascular events, and kidney outcomes. Method We prospectively followed 4219 patients with stage G1–G5 CKD who underwent hs-CRP measurements between 2013 and 2017. Determinants of hs-CRP ≥2 mg/L were evaluated using logistic regression. Cox regression models assessed the association between hs-CRP categories and adverse outcomes, including all-cause mortality, major cardiovascular events, and end-stage kidney failure. Results The median hs-CRP level was 0.53 mg/L, with 19% of participants having hs-CRP ≥2 mg/L. Cross-sectional analyses showed that hs-CRP ≥2 mg/L was negatively correlated with urine albumin, total cholesterol, serum albumin, and statin use, and positively correlated with systolic blood pressure and beta-blocker use. During a median follow-up of 4.5 years, 413 participants died, 365 experienced cardiovascular events, and 830 progressed to end-stage kidney failure. The cumulative incidence of these outcomes increased linearly with higher hs-CRP levels (log-rank P < 0.05). Compared to participants with hs-CRP <1.0 mg/L, those with hs-CRP ≥3.0 mg/L had significantly higher risks of all-cause mortality (hazard ratio [HR] 2.00, 95% confidence interval [CI] 1.57–2.54) and major cardiovascular events (HR 1.63, 95% CI 1.23–2.14). No significant association was observed between hs-CRP levels and kidney outcomes. Conclusion Approximately 20% of non-dialysis-dependent CKD patients exhibited systemic inflammation, as indicated by elevated hs-CRP levels. Higher hs-CRP levels were associated with increased risks of mortality and cardiovascular events but not with adverse kidney outcomes.