Acute Phase Reactants as Predictors of CKD Incidence in Africans: The RODAM Cohort Study

Abstract Background Chronic kidney disease (CKD) and chronic inflammation are highly prevalent in African populations, yet their relationship remains understudied. We examined the association between acute phase reactants (C-reactive protein and ferritin) as markers of acute and chronic inflammation and the incidence of CKD seven years later in a prospective Ghanaian population-based cohort. Methods Data from the prospective Research on Obesity and Diabetes among African Migrants (RODAM-Pros) cohort were analyzed, including participants living in rural and urban Ghana, and Ghanaian migrants in the Netherlands. Acute phase reactants were assessed between 2012 and 2015, while CKD incidence was assessed between 2019 and 2021 using the race-free CKD-EPI 2021 equation. Robust Poisson regression models adjusted for potential confounders assessed associations. We explored interactions with age, sex, education, and geographical location, and stratified CRP analyses by established clinical cut-offs. The role of ferritin as an iron storage marker was also evaluated. Results Among 1,435 participants, baseline CRP was not associated with CKD incidence seven years later. Higher ferritin levels were significantly associated with increased risk of CKD (adjusted incidence rate ratio [aIRR] 1.19; 95% CI: 1.04-1.36) and albuminuria (aIRR 1.22; 95% CI: 1.06-1.40), but not with reduced eGFR (aIRR 1.01; 95% CI: 0.95-1.06). No effect modification was observed by age, sex, education, or geographical location. We found no evidence that iron overload or deficiency contributed to the ferritin-CKD relationship. Conclusions Elevated ferritin levels but not CRP levels may predict future risk of CKD in Ghanaians. Multi-population prospective studies with multiple ferritin measurements are needed to better understand the links between ferritin and CKD in Africans. Key messages • Elevated ferritin levels predict future CKD risk in Ghanaians, highlighting ferritin as a potential early biomarker for kidney disease in African populations. • CRP was not linked to CKD incidence, suggesting that not all inflammatory markers are equally relevant for CKD prediction in African settings.