Baseline elevated C reactive protein (CRP) levels are associated with an increased risk of end-stage renal disease (ESRD) in type 2 diabetic patients with chronic kidney disease and anemia, according to a new study.

“When reviewing a patient with these comorbid conditions, the presence of an elevated CRP level may prompt the clinician to explore for potentially modifiable sources of inflammation, such as infection,” investigators led by Finnian R. McCausland, MBBCh, MMSc, of Brigham and Women’s Hospital in Boston, wrote in a paper published online ahead of print in the American Journal of Kidney Diseases.

It remains unknown if interventions that lower CRP levels will lead to a decreased risk of ESRD, the investigators noted.

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The study included 4038 patients with triad of type 2 diabetes, chronic kidney disease (CKD), and anemia. ESRD developed in 668 patients during a median follow-up of 2.2 years and a composite outcome of death or ESRD occurred in 1270 patients during a median follow-up of 2.3 years, Dr McCausland and his colleagues reported.

Patients with CRP levels of 6.9 mg/L or higher at baseline had a statistically significant 32% increased risk of the future development of ESRD and 41% increased risk of a composite outcome of death or ESRD compared with those who had CRP levels of 3.0 mg/L or less, after adjusting for numerous potential confounders.

In addition, CRP levels of 6.9 mg/L or higher were associated with a statistically significant 59% increased risk of death from any cause and 55% increased risk of a cardiovascular composite outcome of death from any cause, nonfatal myocardial infarction, stroke, heart failure, or hospitalization for myocardial ischemia.

The study was a post hoc analysis of TREAT (Trial to Reduce Cardiovascular Events With Aranesp Thearpy). Participants had a mean age of 67 years; 43% were men and 64% were white.

Dr. McCausland’s team acknowledged that their findings may not be generalizable to patients with non-diabetic CKD or patients with diabetic CKD in the absence of anemia.

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