Kidney Week

Abstract: SA-PO416

Metabolic Syndrome, Inflammation, and Risk of Developing CKD in Rheumatoid Arthritis

Session Information

• CKD: Estimating Equations, Incidence, Prevalence, Special Populations
  November 04, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Chronic Kidney Disease (Non-Dialysis)

• 302 CKD: Estimating Equations, Incidence, Prevalence, Special Populations

Authors

• Kochi, Masako, University of the Ryukyus, Nishihara-cho, Japan

Masako Kochi,

• Kohagura, Kentaro, University of the Ryukyus, Nishihara-cho, Japan

Kentaro Kohagura,

• Ohya, Yusuke, University of the Ryukyus, Nishihara-cho, Japan

Yusuke Ohya,

Background

Inflammation is a risk factor for progression of CKD in patients with rheumatoid arthritis (RA) as well as general population. High incidence of metabolic syndrome (MetS) has been reported in RA. MetS is associated with both inflammation and developing CKD. However, the combined effects of MetS and inflammation on the risk of developing CKD are not known in RA. This study aims to examine the relationship between MetS, C-reactive protein (CRP; a marker of inflammation), and the incidence of CKD in RA patients.

Methods

We retrospectively examined a total of 345 RA patients. The outcome of interest was incidence of CKD which was defined as an eGFR<60 mL/min/1.73 m² and/or positive dipstick testing for proteinuria for ≥3 months. MetS was defined as the presence of ≥3 of the following criteria: obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol, high blood pressure, and high fasting glucose level. CRP was used as an inflammation marker, and a high CRP was defined as persistently CRP value of >3 mg/L during the first 6 months of follow-up. Patients were categorized into four subgroups by the presence of MetS and high CRP at baseline: non-MetS with low CRP, non-MetS with high CRP, MetS with low CRP, and MetS with high CRP.

Results

Mean baseline patient age was 57 years, and mean eGFR was 87 ml/minute/1.73 m². Over a median follow-up of 8 years, 47 (14%) patients developed CKD. MetS and high CRP were independently associated with the incidence of CKD，respectively. Subgroup analysis showed that the cumulative incidence of CKD was the highest in patients with MetS / high CRP group compared with all other groups (P < 0.0001, log-rank test). In a multivariate analysis, MetS / high CRP group was significantly associated with increased risk for incident CKD (adjusted HR, 5.35; 95% confidence interval, 2.27–12.71; P = 0.0002) independent of age, eGFR, and anti-RA drug uses.

Conclusion

Independent of confounding risk factors, MetS had an inflammation-augmented association with increased risk of incident CKD in patients with RA.