XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Anil Kumar T, Badam L K, Vanapalli B L. High Sensitivity C-Reactive Protein (hs-CRP) and Uric Acid as Markers of Cardiovascular Risk in Chronic Kidney Disease Patients. Journal of Research in Applied and Basic Medical Sciences 2024; 10 (3) :224-232
URL: http://ijrabms.umsu.ac.ir/article-1-325-en.html
Professor & HOD, Department of Biochemistry, Rangaraya Medical College, Kakinada, Andhra Pradesh, India , biochem2102@gmail.com
Abstract:   (433 Views)
Background & Aims: The link between Chronic Kidney Disease (CKD) and Cardio Vascular Disease (CVD) has long been established. Hyperuricemia and inflammatory markers such as hs-CRP are considered to be non-traditional risk factors for cardiovascular risk in CKD patients. The aim of this study was to estimate serum hs-CRP and uric acid levels in patients with chronic kidney disease along with age and sex matched healthy controls and see whether they are statistically significant or not.
Materials & Methods: In this case-control study, totally 30 cases with ages varied from 30-70 years and 30 age and sex matched controls were selected based on inclusion and exclusion criteria. Serum CRP and Uric Acid were analyzed on Beckman Coulter AU-480 fully automated analyser, by Turbidimetric end point method and Modified Trinder end point method, respectively. Qualitative data is expressed as proportion and percentage while quantitative data is expressed as mean+SD. Statistical analysis is done using Microsoft Excel sheet and Graph pad software. A p value <0.05 is considered as statistically significant.
Results: Results show that the patients with CKD had higher levels of hs-CRP and Uric Acid than healthy controls, implying a higher risk of cardiovascular disease in this group.
Conclusion: The present study implies that regular monitoring of these biomarkers is required in CKD patients, to assess the progression of atherosclerosis and evaluate potential interventions, thereby preventing morbidity & mortality due to cardiovascular disease.
Full-Text [PDF 289 kb]   (202 Downloads)    
Type of Study: orginal article | Subject: General

References
1. Bright R. Cases and observations, illustrative of renal disease, accompanied with the secretion of albuminous urine. Guys Hosp Trans 1836:338- 79. [PMCID]
2. Stevens PE, O'Donoghue DJ, de Lusignan S, Van Vlymen J, Klebe B, Middleton R, Hague N, New J, Farmer CK. Chronic kidney disease management in the United Kingdom: NEOERICA project results. Kidney Int 2007;72:92-9. [DOI:10.1038/sj.ki.5002273]
3. Thompson S, James M, Wiebe N, Hemmelgarn B, Manns B, Klarenbach S, Tonelli M; Alberta Kidney Disease Network. Cause of death in patients with reduced kidney function. J Am Soc Nephrol 2015; 26:2504-11. [DOI:10.1681/ASN.2014070714]
4. Webster AC, Nagler EV, Morton RL, Masson P. Chronic kidney disease. Lancet. 2017; 389:1238-52. [DOI:10.1016/S0140-6736(16)32064-5]
5. Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998;32(5 suppl 3):S112-9. [DOI:10.1053/ajkd.1998.v32.pm9820470]
6. Sjoblom P, Nystrom FH, Lanne T, Engvall J, Ostgren CJ. Microalbuminuria, but not reduced eGFR, is associated with cardiovascular subclinical organ damage in type 2 diabetes. Diabetes Metab 2014;40:49-55. [DOI:10.1016/j.diabet.2013.09.008]
7. Nasrallah R, Hassouneh R, Hébert RL. PGE2, kidney disease, and cardiovascular risk: beyond hypertension and diabetes. J Am Soc Nephrol 2016;27:666-76. [DOI:10.1681/ASN.2015050528]
8. Sedaghat S, Mattace-Raso FU, Hoorn EJ, et al. Arterial stiffness and decline in kidney function. Clin J Am Soc Nephrol 2015;10:2190-7. [DOI:10.2215/CJN.03000315]
9. Wachtell K, Olsen MH. Is it time to change the definition of normal urinary albumin excretion? Nat Clin Pract Nephrol 2008;4:650-51. [DOI:10.1038/ncpneph0971]
10. Dalrymple LS, Katz R, Kestenbaum B , et al. Chronic kidney disease and the risk of end-stage renal disease versus death. J Gen Intern Med 2011;26:379-85. [DOI:10.1007/s11606-010-1511-x]
11. Sparks MA, Crowley SD, Gurley SB, Mirotsou M, Coffman TM. Classical renin-Angiotensin system in kidney physiology. Compr Physiol 2014;4:1201-28. [DOI:10.1002/cphy.c130040]
12. Lopez-Giacoman S, Madero M. Biomarkers in chronic kidney disease, from kidney function to kidney damage. World J Nephrol 2015; 4(1):57. [DOI:10.5527/wjn.v4.i1.57]
13. Price AM, Ferro CJ, Hayer MK, Steeds RP, Edwards NC, Townend JN. Premature coronary artery disease and early stage chronic kidney disease. QJM In J Med 2018;111(10):683-6. [DOI:10.1093/qjmed/hcx179]
14. Shlipak MG, Fried LF, Cushman M, et al. Cardiovascular mortality risk in chronic kidney disease: comparison of traditional and novel risk factors. JAMA 2005;293(14):1737-45. [DOI:10.1001/jama.293.14.1737]
15. Nakamura K, Nakagawa H, Murakami Y, et al. Smoking increases the risk of all-cause and cardiovascular mortality in patients with chronic kidney disease. Kidney Int 2015;88(5):1144-52. [DOI:10.1038/ki.2015.212]
16. Shlipak MG, Fried LF, Crump C, Bleyer AJ, Manolio TA, Tracy RP, Furberg CD, Psaty BM. Elevations of inflammatory and procoagulant biomarkers in elderly persons with renal insufficiency. Circulation 2013;107(1):87-92. [DOI:10.1161/01.CIR.0000042700.48769.59]
17. Venugopal SK, Devaraj S, Yuhanna I, et al. Demonstration that C-reactive protein decreases eNOS expression and bioactivity in human aortic endothelial cells. Circulation 2002;106:1439-41. [DOI:10.1161/01.CIR.0000033116.22237.F9]
18. Locatelli F, Marcelli D, Conte F, D'Amico M, Del Vecchio L, Limido A et al. Cardiovascular disease in chronic renal failure: the challenge continues. Nephrol Dial Transplant 2000;15(Suppl 5):69-80 [DOI:10.1093/ndt/15.suppl_5.69]
19. Foley RN, Parfey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998;339:841-3. [DOI:10.1053/ajkd.1998.v32.pm9820470]
20. Arici M, Walls J. End stage renal disease, atherosclerosis, and cardiovascular mortality: Is C-reactive protein the missing link? Kidney Int 2001; 9:407-17. [DOI:10.1046/j.1523-1755.2001.059002407.x]
21. Whaley-Connell AT, Sowers JR, Stevens LA, et al. CKD in the United States: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey(NHANES) 1999-2004. Am J Kidney Dis 2008;51:S13-20. [DOI:10.1053/j.ajkd.2007.12.016]
22. Muntner P, He J, Astor BC, et al. Traditional and nontraditional risk factors predict coronary heart disease in chronic kidney disease: results from the atherosclerosis risk in communities study. J Am Soc Nephrol 2005;16:529-38. [DOI:10.1681/ASN.2004080656]
23. Gansevoort RT, Correa-Rotter R, Hemmelgarn BR et al. Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet 2013;382:339-52. [DOI:10.1016/S0140-6736(13)60595-4]
24. Shlipak MG, Fried LF, Cushman M, et al. Cardiovascular mortality risk in chronic kidney disease: comparison of traditional and novel risk factors. JAMA 2005;293:1737-45. [DOI:10.1001/jama.293.14.1737]
25. Matsushita K, van der Velde M, Astor BC, et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 2010;375(9731):2073-81. [DOI:10.1016/S0140-6736(10)60674-5]
26. Cachofeiro V, Goicochea M, de Vinuesa SG, et al. Oxidative stress and inflammation, a link between chronic kidney disease and cardiovascular disease. Kidney Int Suppl 2008;74:S4-S9. [DOI:10.1038/ki.2008.516]
27. Orth SR, Hallan SI. Risk factor for progression of chronic kidney disease and for cardiovascular morbidity and mortality in renal patients--absence of evidence or evidence ofAbsence? Clin J Am Soc Nephrol 2008;3(1):226-36. [DOI:10.2215/CJN.03740907]
28. Manjunath G, Tighiouart H, Coresh J et al. Level of kidney function as a risk factor forCardiovascular outcomes in the elderly. Kidney Int 2003;63:1121-9. [DOI:10.1046/j.1523-1755.2003.00838.x]
29. Agharazii M, St-Louis R, Gautier-Bastien A, Ung RV, Mokas S, Larivière R, Richard DE. Inflammatory cytokines and reactive oxygen species as mediators of chronic kidney disease-related vascular calcification. Am J Hypertens 2015;28:746-55. [DOI:10.1093/ajh/hpu225]
30. Fujii H, Goto S, Fukagawa M. Role of uremic toxins for kidney, cardiovascular, and bone dysfunction. Toxins 2018;10:202-220. [DOI:10.3390/toxins10050202]
31. Friedman AN, Hunsicker LG, Selhub J, et al. C-reactive protein as a predictor of totalarteriosclerotic outcomes in type 2 diabetic nephropathy. Kidney Int 2005;68:773-8. [DOI:10.1111/j.1523-1755.2005.00456.x]
32. Albert MA, Glynn RJ, Ridker PM (2003) Plasma concentration of c-reactive protein and the calculated Framingham Coronary Heart Disease Risk Score. Circulation 108:161-5. [DOI:10.1161/01.CIR.0000080289.72166.CF]
33. MENON V, GREENE T, WANG X, et al: C-reactive protein and serum albumin as predictors of all-cause and cardiovascular mortality in patients with chronic kidney disease. Kidney Int 2005;68:766-72. [DOI:10.1111/j.1523-1755.2005.00455.x]
34. Knight EL, Rimm EB, Pai JK, et al: Kidney dysfunction, inflammation, and coronary events: A prospective study. J Am Soc Nephrol 2004;15:1897-1903. [DOI:10.1097/01.ASN.0000128966.55133.69]
35. Stenvinkel P, Ketteler M, Johnson RJ, et al: IL-10, IL-6, and TNF alpha: Central factors in the altered cytokine network of uremia. The good, the bad, and the ugly. Kidney Int 2005;67:1216-33. [DOI:10.1111/j.1523-1755.2005.00200.x]
36. Zwaka TP, Hombach V, Torzewski J. C-reactive protein-mediated low density lipoprotein uptake by macrophages: implications for atherosclerosis. Circulation 2001;103:1194-7. [DOI:10.1161/01.CIR.103.9.1194]
37. Verma S, Wang CH, Li SH, et al. A self-fulfilling prophecy: C-reactive protein attenuates nitric oxide production and inhibits angiogenesis. Circulation 2002;106:913-9. [DOI:10.1161/01.CIR.0000029802.88087.5E]
38. Qamirani E, Ren Y, Kuo L, et al. C-reactive protein inhibits endothelium-dependent NO-mediated dilation in coronary arterioles by activating p38 kinase and NAD(P)H oxidase.Arterioscler Thromb Vasc Biol 2005;25:995-1001. [DOI:10.1161/01.ATV.0000159890.10526.1e]
39. Buglioni A, Burnett JC Jr. Pathophysiology and the cardiorenal connection in heart failure. Circulating hormones: biomarkers or mediators. Clin Chim Acta 2015;443:3-8. [DOI:10.1016/j.cca.2014.10.027]
40. Kopel T, Kaufman JS, Hamburg N, Sampalis JS, Vita JA (2017) Dember LM. Endothelium-dependent and -independent vascular function in advanced chronic kidney disease. Clin J Am Soc Nephrol2017;12:1588-94. [DOI:10.2215/CJN.12811216]
41. Weiner DE, Tighiouart H, Elsayed EF, et al. The relationship between nontraditional risk factors and outcomes in individuals with stage 3 to 4 CKD. Am J Kidney Dis 2008; 51(2):212-23. [DOI:10.1053/j.ajkd.2007.10.035]
42. Kanbay M, Yilmaz MI, Sonmez A, et al. Serum uric acid independently predicts cardiovascular events in advanced nephropathy. Am J Nephrol 2012;36(4):324-31. [DOI:10.1159/000342390]
43. Xia X, Zhao C, Peng FF, et al. Serum uric acid predicts cardiovascular mortality in male peritoneal dialysis patients with diabetes. Nutr Metab Cardiovasc Dis 2016;26(1):20-6. [DOI:10.1016/j.numecd.2015.10.011]
44. Li M, Hou W, Zhang X, Hu L, Tang Z. Hyperuricemia and risk of stroke: a systematic review and meta-analysis of prospective studies. Atherosclerosis 2014;232(2):265-70. [DOI:10.1016/j.atherosclerosis.2013.11.051]
45. Wen CP, Cheng TY, Chan HT, Tsai MK, Chung IW, Tsai SP, Wu SB, Wen SF. Is High Serum Uric Acid a Risk Marker or a Target for Treatment? Examination of Individuals with Low Cardiovascular Risk in a Large Cohort. Am J Kidney Dis 2010;2:53-59. [DOI:10.1053/j.ajkd.2010.01.024]
46. Grayson PC, Kim SY, LaValley M, Choi HK. Hyperuricemia and incident hypertension: a systematic review and meta-analysis. Arthritis Care Res 2011;63(1):102-10 [DOI:10.1002/acr.20344]
47. Kim SY, Guevara JP, Kim KM, Choi HK, Heitjan DF, Albert DA. Hyperuricemia and risk of stroke: a systematic review and meta-analysis. Arthritis Rheum 2009;61(7):885-92. [DOI:10.1002/art.24612]
48. Huang H, Huang B, Li Y, et al. Uric acid and risk of heart failure: a systematic review and meta-analysis. Eur J Heart Fail 2014;16(1):15-24. [DOI:10.1093/eurjhf/hft132]
49. Liu X, Zhai T, Ma R, et al. Effects of uric acid-lowering therapy on the progression ofChronic kidney disease: a systematic review and meta-analysis. Ren Fail. 2018; 40:289-297. [DOI:10.1080/0886022X.2018.1456463]
50. Madero M: High levels of uric acid linked to CKD death risk. Renal Urol News 2008. [URL]
51. Cristobal-Garcia M, Garcia-Arroyo FE, Tapia E. Renal oxidative stress induced by long-Term hyperuricemia alters mitochondrial function and maintains systemic hypertension. Oxid Med Cell Longev 2015;2015:535686. [DOI:10.1155/2015/535686]
52. Zazueta C, Johnson RJ, Lozada LG, et al. Soluble uric acid increases NALP3 inflammasome and interleukin-1beta expression in human primary renal proximal tubule epithelial cells through the toll-like receptor 4-mediated pathway. Oxidative Med Cell Longev 2015;35(5):1347-54. [DOI:10.3892/ijmm.2015.2148]
53. Prasad Sah OS, Qing YX. Associations between hyperuricemia and chronic kidney disease: a review. Nephrourol Mon 2015;7(3):e27233. [DOI:10.5812/numonthly.7(3)2015.27233]
54. Li P, Zhang L, Zhang M, Zhou C, Lin N. Uric acid enhances PKC-dependent eNOS phosphorylation and mediates cellular ER stress: a mechanism for uric acid-induced endothelial dysfunction. Int J Mol Med 2016;37(4):989-97. [DOI:10.3892/ijmm.2016.2491]
55. Fang JI, Wu JS, Yang YC, Wang RH, Lu FH, Chang CJ. High uric acid level associated with increased arterial stiffness in apparently healthy women. Atherosclerosis 2014;236:389-93. [DOI:10.1016/j.atherosclerosis.2014.07.024]
56. Edwards NC, Moody WE, Yuan M, et al. Diffuse interstitial fibrosis and myocardial dysfunction in early chronic kidney disease. Am J Cardiol 2015;115(9):1311-7. [DOI:10.1016/j.amjcard.2015.02.015]
57. Kim SY, Guevara JP, Kim KM, Choi HK, Heitjan DF, Albert DA: Hyperuricemia and coronary heart disease: a systematic review and meta-analysis. Arthritis Care Res 2010;62(2):170-80. [DOI:10.1002/acr.20065]
58. Grossman C, Shemesh J, Koren-Morag N, Bornstein G, Ben-Zvi I, Grossman E: Serum uric acid is associated with coronary artery calcification. J Clin Hypertens 2014;16(6):424-8. [DOI:10.1111/jch.12313]
59. Kivity S, Kopel E, Maor E, et al. Association of serum uric acid and cardiovascular disease in healthy adults. Am J Cardiol 2013;111(8):1146-51. [DOI:10.1016/j.amjcard.2012.12.034]
60. Zhao G, Huang L, Song M, Song Y. Baseline serum uric acid level as a predictor of cardiovascular disease related mortality and all-cause mortality: a meta-analysis of prospective studies. Atherosclerosis 2013;231(1):61-8. [DOI:10.1016/j.atherosclerosis.2013.08.023]
61. Khosla UM, Zharikov S, Finch JL, Nakagawa T, Roncal C, Mu W, Krotova K, Block ER, Prabhakar S, Johnson RJ: Hyperuricemia induces endothelial dysfunction. Kidney Int 2005;67(5):1739-42. [DOI:10.1111/j.1523-1755.2005.00273.x]
62. Yu MA, Sanchez-Lozada LG, Johnson RJ, Kang DH: Oxidative stress with an activation of the renin angiotensin system in human vascular endothelial cells as a novel mechanism of uric acid-induced endothelial dysfunction. J Hypertens 2010;28(6):1234-42. [DOI:10.1097/HJH.0b013e328337da1d]
63. Kang DH, Park SK, Lee IK, Johnson RJ: Uric acid-induced C-reactive protein expression: implication on cell proliferation and nitric oxide production of human vascular cells. J Am Soc Nephrol 2005;16(12):3553-62. 5050572 [DOI:10.1681/ASN.200]

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | Journal of Research in Applied and Basic Medical Sciences

Designed & Developed by : Yektaweb