Association of Serum Ig Free Light Chains with Mortality and ESRD among Patients with Nondialysis-Dependent CKD
| Autor: | Paul Cockwell, Philip A. Kalra, Richard Hoefield, Anne Burmeister, Lakhvir K. Assi, James Ritchie |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Epidemiology Critical Care and Intensive Care Medicine Phosphates Predictive Value of Tests Risk Factors Interquartile range Cause of Death Internal medicine Humans Medicine Prospective Studies Renal Insufficiency Chronic Risk factor Prospective cohort study Aged Cause of death Transplantation business.industry Hazard ratio Age Factors Original Articles Middle Aged Confidence interval Survival Rate Proteinuria Endocrinology Quartile Cardiovascular Diseases Nephrology Creatinine Cohort Disease Progression Kidney Failure Chronic Female Immunoglobulin Light Chains business Glomerular Filtration Rate |
| Zdroj: | Clinical Journal of the American Society of Nephrology. 10:740-749 |
| ISSN: | 1555-9041 |
| DOI: | 10.2215/cjn.09660914 |
| Popis: | High levels of serum polyclonal combined Ig free light chains are associated with inflammation and decreased excretory kidney function, and they are an independent risk factor for mortality. Whether combined Ig free light chain predicted mortality and progression to ESRD in a stages 3-5 CKD cohort was assessed.This was a prospective cohort study of 872 patients with stages 3-5 CKD (nondialysis) recruited into the Chronic Renal Insufficiency Standards Implementation Study. Patients were recruited to the Chronic Renal Insufficiency Standards Implementation Study in an unselected manner from secondary care nephrology clinics between 2004 and 2010. Combined Ig free light chain was measured at recruitment and analyzed by quartiles. The cohort was followed up for a median of 41.4 months (interquartile range =28.3-68.0 months). Cox regression analysis was undertaken to determine the variables associated with mortality and progression to ESRD.Combined Ig free light chain quartiles were49.4, 49.4-68.8, 68.9-100.7, and100.7 mg/L. An independent association with death and progression to ESRD was associated with the third and fourth combined Ig free light chain quartiles (quartile 3: death: hazard ratio, 1.49; 95% confidence interval, 1.02 to 2.18; P=0.04; ESRD: hazard ratio, 1.72; 95% confidence interval, 1.0 to 2.97; P=0.05; quartile 4: death: hazard ratio, 1.99; 95% confidence interval, 1.34 to 2.93; P0.001; ESRD: hazard ratio, 3.73; 95% confidence interval, 2.1 to 6.3; P0.001). The other independent risk factors were (1) preexisting cardiovascular disease, age65 years old, and eGFR=15-30 ml/min per 1.73 m(2) for death and (2) age ≤65 years old, eGFR30 ml/min per 1.73 m(2), urinary protein-to-creatinine ratio30 mg/mmol, and serum phosphate level4.65 mg/dl for progression to ESRD.An elevated serum combined Ig free light chain level is an independent risk factor for mortality and progression to ESRD in patients with stages 3-5 CKD managed in secondary care. |
| Databáze: | OpenAIRE |
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