Higher hsCRP linked to cardio-kidney outcomes in moderate-to-severe CKD

Researchers studied 23,008 adults with stage 3–5 chronic kidney disease enrolled in the Swedish Renal Registry between 2008 and 2023. Inflammation was assessed using 94,500 repeated high-sensitivity C-reactive protein (hsCRP) measurements. Time-varying Cox models accounting for competing risks examined associations with major adverse cardiovascular events (MACE), heart failure hospitalization, acute kidney injury (AKI), kidney failure requiring replacement therapy (KFRT) and all-cause mortality. Participants had a mean age of 71 years; median eGFR was 25 mL/min/1.73 m². Median follow-up was 3.9 years.

An hsCRP level of at least 2 mg/L was associated with higher rates of all outcomes: MACE (hazard ratio [HR] 1.20, 95% CI 1.12–1.28), heart failure hospitalization (HR 1.29, 1.22–1.37), AKI (HR 1.28, 1.18–1.38), KFRT (HR 1.09, 1.02–1.15) and all-cause mortality (HR 1.43, 1.37–1.50). Associations with MACE, heart failure, AKI and mortality were similar across atherosclerotic cardiovascular disease history and CKD stage; KFRT associations varied by stage.

The findings show that higher hsCRP is associated with adverse outcomes in this nephrology-care cohort, but the observational design cannot establish causality or show that hsCRP-guided monitoring improves outcomes. The association with KFRT was weaker and less consistent than for other outcomes.