Kidney Week

Abstract: SA-PO1219

Systemic Inflammation and Risk of Adverse Kidney Outcomes in a Veteran Affairs Population with Atherosclerotic Cardiovascular Disease and CKD

Session Information

• CKD: Biomarkers and Emerging Tools for Diagnosis and Monitoring
  November 08, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Zitko, Kimberly, Novo Nordisk Inc, Plainsboro, New Jersey, United States

Kimberly Zitko, PharmD

• Sandhu, Alexander T, Department of Medicine, Stanford University, Stanford, California, United States

Alexander T Sandhu, MD, MS

• Furst, Adam, Department of Medicine, Stanford University, Stanford, California, United States

Adam Furst

• Maron, David, Department of Medicine, Stanford University, Stanford, California, United States

David Maron

• Nallamshetty, Shriram, Department of Medicine, Stanford University, Stanford, California, United States

Shriram Nallamshetty, MD

• Din, Natasha, Palo Alto Veterans Affairs Healthcare System, Palo Alto, California, United States

Natasha Din, MD, MAS

• Khachatourian, Kat, Novo Nordisk Inc, Plainsboro, New Jersey, United States

Kat Khachatourian

• Skaar, Jeffrey R, Novo Nordisk Inc, Plainsboro, New Jersey, United States

Jeffrey R Skaar, PhD

• Tonnu-Mihara, Ivy, Novo Nordisk Inc, Plainsboro, New Jersey, United States

Ivy Tonnu-Mihara, PharmD

Background

Systemic inflammation (SI) plays a role in adverse outcomes related to cardiovascular-kidney-metabolic (CKM) diseases and may be an underlying mechanism for their interconnectedness. High-sensitivity C-reactive protein (hsCRP) is a biomarker for SI, with strong predictive value for cardiovascular (CV) risk. data on the association between SI and renal- endpoints in patients with comorbid atherosclerotic cardiovascular disease (ASCVD) and chronic kidney disease (CKD) is scarce. We evaluated the relationship between SI and CKD outcomes among patients with ASCVD and CKD using Veterans Health Administration data.

Methods

Veterans with ASCVD, CKD, & outpatient hsCRP measurement were included. SI was defined as hsCRP 2-10 mg/L. Those with hsCRP >10 mg/L were included in sensitivity analysis. ASCVD was identified based on diagnoses or prior revascularization. CKD was defined by estimated glomerular filtration rate (eGFR) (>15 and <60 mL/min/1.73 m²; CKD stages 3-4) or eGFR >60 mL/min/1.73 m² with urinary albumin to creatinine ratio (UACR) >200mg/g. Veterans with comorbidities known to increase SI and mortality were excluded. Cox regressions were used to assessthe association of SI with risk of end-stage renal disease (ESRD) [defined as eGFR <15 mL/min/1.73 m² or dialysis], dialysis, death due to kidney disease, or all-cause death.

Results

Of 94,166 Veterans, 48, 224 (51.2%) had SI. Among Veterans with SI, mean age was 73 years (SD: 9), 96.0% were men, eGFR was 49 mL/min/1.73 m² (SD: 13), and UACR was 199 mg/g (SD: 1778). Individuals with SI had higher incidence of ESRD compared to those without (3.60 events/100 vs. 2. 48/100 patient-years). The association was consistent after adjusting for confounders (HR: 1.16; 95% CI: 1.11-1.22) and in sensitivity analysis [4.06 events/100 patient years (95% CI: 3.99-4.13)]. SI was associated with death due to kidney disease and all-cause death in adjusted and unadjusted analyses (all p<0.05).

Conclusion

SI was associated with increased risk of adverse renal outcomes and all cause death in patients with ASCVD & CKD. These results may support the role of hsCRP in identifying individuals at high risk of CKD progression and death in this population.

Funding

• Commercial Support – Novo Nordisk

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025eqbc1mkv