Inflammation and Trajectory of Renal Function in Community‐Dwelling Older Adults

• Autores: Shabnam Salimi, Michelle Shardell, Stephen L. Seliger, Stefania Bandinelli, Jack M. Guralnik, Luigi Ferrucci
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 66, Nº. 4, 2018, págs. 804-811
• Idioma: inglés
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• Resumen

  • Objectives To examine the hypothesis that the inflammatory state of aging is a risk factor for accelerated renal function (RF) decline using inflammatory biomarkers and RF measures collected over 9 years of follow‐up in relatively healthy individuals enrolled in the Invecchiare in Chianti study.

    Design Longitudinal.

    Setting Community.

    Participants Individuals aged 60 and older with baseline estimated glomerular filtration rate (eGFR) of 60 mL/min per 1.73 m2 and greater and no diabetes mellitus (DM) (N = 687).

    Measures eGFR, as a proxy for RF, was determined using the Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) equation at baseline and 3‐, 6‐, and 9‐year follow‐up. Incident chronic kidney disease (CKD) was defined as new‐onset eGFR less than 60 mL/min per 1.73 m2 at each follow‐up. Predictors included baseline and time‐dependent inflammatory biomarkers: soluble tumor necrosis factor alpha receptors (sTNFα‐R1 and ‐R2), interleukin (IL)‐6, IL‐18, IL‐1β, IL‐1 receptor antagonist, and high‐sensitivity C‐reactive protein.

    Results Higher baseline sTNFα‐R1 was significantly associated with lower eGFR over 9 years, independent of DM or blood pressure (baseline: urn:x-wiley:00028614:media:jgs15268:jgs15268-math-0001 = −0.39, P = .001; 3‐year: urn:x-wiley:00028614:media:jgs15268:jgs15268-math-0002 = −0.26, P = .001; 6‐year: urn:x-wiley:00028614:media:jgs15268:jgs15268-math-0003 = −0.36, P = .001; 9‐year: urn:x-wiley:00028614:media:jgs15268:jgs15268-math-0004 = −0.47, P = .001). The rate of TNFα‐R1 change was significantly associated with rate of eGFR change (urn:x-wiley:00028614:media:jgs15268:jgs15268-math-0005 = −0.18, P = .001). Baseline sTNFα‐R1 predicted incident CKD (per 1‐standard deviation increment: 3‐year: relative risk (RR) = 1.3, 95% confidence interval (CI) = 1.1–1.5; 6‐year: RR = 1.5, 95% CI = 1.1–2.2; 9‐year RR = 1.6, 95% CI = 1.1–2.2). Similar results were found for sTNFα‐R2.

    Conclusion Baseline TNFα‐R levels and their rates of change were significantly associated with RF decline and incident CKD in older adults independent of DM or blood pressure.