Inflammatory Markers and Incidence of Hospitalization With Infection in Chronic Kidney Disease.

Journal Article (Journal Article)

Persons with chronic kidney disease (CKD) are at high risk of infection. While low-grade inflammation could impair immune response, it is unknown whether inflammatory markers are associated with infection risk in this clinical population. Using 2003-2013 data from the Chronic Renal Insufficiency Cohort Study (3,597 participants with CKD), we assessed the association of baseline plasma levels of 4 inflammatory markers (interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-1 receptor antagonist (IL-1RA), and transforming growth factor-β (TGF-β)) with incident hospitalization with major infection (pneumonia, urinary tract infection, cellulitis and osteomyelitis, and bacteremia and sepsis). During follow-up (median 7.5 years), 36% (n = 1,290) had incident hospitalization with major infection. In multivariable Cox analyses with each inflammatory marker modeled as a restricted cubic spline, higher levels of IL-6 and TNF-α were monotonically associated with increased risk of hospitalization with major infection (for 95th vs. 5th percentile, hazard ratio = 2.11 (95% confidence interval: 1.68, 2.66) for IL-6 and 1.88 (95% confidence interval: 1.51, 2.33) for TNF-α), while corresponding associations for IL-1RA or TGF-β were nonsignificant. Thus, higher plasma levels of IL-6 and TNF-α, but not IL-1RA or TGF-β, were significantly associated with increased risk of hospitalization with major infection. Future studies should investigate whether inflammatory pathways that involve IL-6 and TNF-α increase susceptibility to infection among individuals with CKD.

Full Text

Duke Authors

Cited Authors

  • Ishigami, J; Taliercio, J; I Feldman, H; Srivastava, A; Townsend, R; L Cohen, D; Horwitz, E; Rao, P; Charleston, J; Fink, JC; Ricardo, AC; Sondheimer, J; Chen, TK; Wolf, M; Isakova, T; Appel, LJ; Matsushita, K; CRIC Study Investigators,

Published Date

  • May 5, 2020

Published In

Volume / Issue

  • 189 / 5

Start / End Page

  • 433 - 444

PubMed ID

  • 31673705

Pubmed Central ID

  • PMC7306687

Electronic International Standard Serial Number (EISSN)

  • 1476-6256

Digital Object Identifier (DOI)

  • 10.1093/aje/kwz246


  • eng

Conference Location

  • United States