Racial differences in inflammation and outcomes of aging among kidney transplant candidates
Abstract Background Inflammation is more common among African Americans (AAs), and it is associated with frailty, poor physical performance, and mortality in community-dwelling older adults. Given the elevated inflammation levels among end-stage renal disease (ESRD) patients, inflammation may be ass...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-05-01
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| Series: | BMC Nephrology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12882-019-1360-8 |
| _version_ | 1819241545407135744 |
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| author | Prakriti Shrestha Christine E. Haugen Nadia M. Chu Ashton Shaffer Jacqueline Garonzik-Wang Silas P. Norman Jeremy D. Walston Dorry L. Segev Mara A. McAdams-DeMarco |
| author_facet | Prakriti Shrestha Christine E. Haugen Nadia M. Chu Ashton Shaffer Jacqueline Garonzik-Wang Silas P. Norman Jeremy D. Walston Dorry L. Segev Mara A. McAdams-DeMarco |
| author_sort | Prakriti Shrestha |
| collection | DOAJ |
| description | Abstract Background Inflammation is more common among African Americans (AAs), and it is associated with frailty, poor physical performance, and mortality in community-dwelling older adults. Given the elevated inflammation levels among end-stage renal disease (ESRD) patients, inflammation may be associated with adverse health outcomes such as frailty, physical impairment, and poor health-related quality of life (HRQOL), and these associations may differ between AA and non-AA ESRD patients. Methods One thousand three ESRD participants were recruited at kidney transplant evaluation (4/2014–5/2017), and inflammatory markers (interleukin-6 [IL-6], tumor necrosis factor-a receptor-1 [TNFR1], C-reactive protein [CRP]) were measured. We quantified the association with frailty (Fried phenotype), physical impairment (Short Physical Performance Battery [SPPB]), and fair/poor HRQOL at evaluation using adjusted modified Poisson regression and tested whether these associations differed by race (AA vs. non-AA). Results Non-AAs had lower levels of TNFR1 (9.7 ng/ml vs 14.0 ng/ml, p < 0.001) and inflammatory index (6.7 vs 6.8, p < 0.001) compared to AAs, but similar levels of IL-6 (4.5 pg/ml vs 4.3 pg/ml, p > 0.9) and CRP (4.7 μg/ml vs 4.9 μg/ml, p = 0.4). Non-AAs had an increased risk of frailty with elevated IL-6 (RR = 1.58, 95% CI:1.27–1.96, p < 0.001), TNFR1 (RR = 1.60, 95% CI:1.25–2.05, p < 0.001), CRP (RR = 1.41, 95% CI:1.10–1.82, p < 0.01), and inflammatory index (RR = 1.82, 95% CI:1.44–2.31, p < 0.001). The associations between elevated inflammatory markers and frailty were not present among AAs. Similar results were seen with SPPB impairment and poor/fair HRQOL. Conclusions Non-AAs with elevated inflammatory markers may need closer follow-up and may benefit from prehabilitation to improve physical function, reduce frailty burden, and improve quality of life prior to transplant. |
| first_indexed | 2024-12-23T14:25:37Z |
| format | Article |
| id | doaj.art-d336b946b7a44d79a8b4d667bbc1f63a |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-12-23T14:25:37Z |
| publishDate | 2019-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-d336b946b7a44d79a8b4d667bbc1f63a2022-12-21T17:43:41ZengBMCBMC Nephrology1471-23692019-05-012011810.1186/s12882-019-1360-8Racial differences in inflammation and outcomes of aging among kidney transplant candidatesPrakriti Shrestha0Christine E. Haugen1Nadia M. Chu2Ashton Shaffer3Jacqueline Garonzik-Wang4Silas P. Norman5Jeremy D. Walston6Dorry L. Segev7Mara A. McAdams-DeMarco8Department of Surgery, Johns Hopkins University School of MedicineDepartment of Surgery, Johns Hopkins University School of MedicineDepartment of Surgery, Johns Hopkins University School of MedicineDepartment of Surgery, Johns Hopkins University School of MedicineDepartment of Surgery, Johns Hopkins University School of MedicineDepartment of Medicine, Division of Nephrology, University of MichiganDepartment of Medicine, Division of Geriatrics, Johns Hopkins University School of MedicineDepartment of Surgery, Johns Hopkins University School of MedicineDepartment of Surgery, Johns Hopkins University School of MedicineAbstract Background Inflammation is more common among African Americans (AAs), and it is associated with frailty, poor physical performance, and mortality in community-dwelling older adults. Given the elevated inflammation levels among end-stage renal disease (ESRD) patients, inflammation may be associated with adverse health outcomes such as frailty, physical impairment, and poor health-related quality of life (HRQOL), and these associations may differ between AA and non-AA ESRD patients. Methods One thousand three ESRD participants were recruited at kidney transplant evaluation (4/2014–5/2017), and inflammatory markers (interleukin-6 [IL-6], tumor necrosis factor-a receptor-1 [TNFR1], C-reactive protein [CRP]) were measured. We quantified the association with frailty (Fried phenotype), physical impairment (Short Physical Performance Battery [SPPB]), and fair/poor HRQOL at evaluation using adjusted modified Poisson regression and tested whether these associations differed by race (AA vs. non-AA). Results Non-AAs had lower levels of TNFR1 (9.7 ng/ml vs 14.0 ng/ml, p < 0.001) and inflammatory index (6.7 vs 6.8, p < 0.001) compared to AAs, but similar levels of IL-6 (4.5 pg/ml vs 4.3 pg/ml, p > 0.9) and CRP (4.7 μg/ml vs 4.9 μg/ml, p = 0.4). Non-AAs had an increased risk of frailty with elevated IL-6 (RR = 1.58, 95% CI:1.27–1.96, p < 0.001), TNFR1 (RR = 1.60, 95% CI:1.25–2.05, p < 0.001), CRP (RR = 1.41, 95% CI:1.10–1.82, p < 0.01), and inflammatory index (RR = 1.82, 95% CI:1.44–2.31, p < 0.001). The associations between elevated inflammatory markers and frailty were not present among AAs. Similar results were seen with SPPB impairment and poor/fair HRQOL. Conclusions Non-AAs with elevated inflammatory markers may need closer follow-up and may benefit from prehabilitation to improve physical function, reduce frailty burden, and improve quality of life prior to transplant.http://link.springer.com/article/10.1186/s12882-019-1360-8End-stage renal diseaseInflammationRaceFrailtyHRQOL |
| spellingShingle | Prakriti Shrestha Christine E. Haugen Nadia M. Chu Ashton Shaffer Jacqueline Garonzik-Wang Silas P. Norman Jeremy D. Walston Dorry L. Segev Mara A. McAdams-DeMarco Racial differences in inflammation and outcomes of aging among kidney transplant candidates BMC Nephrology End-stage renal disease Inflammation Race Frailty HRQOL |
| title | Racial differences in inflammation and outcomes of aging among kidney transplant candidates |
| title_full | Racial differences in inflammation and outcomes of aging among kidney transplant candidates |
| title_fullStr | Racial differences in inflammation and outcomes of aging among kidney transplant candidates |
| title_full_unstemmed | Racial differences in inflammation and outcomes of aging among kidney transplant candidates |
| title_short | Racial differences in inflammation and outcomes of aging among kidney transplant candidates |
| title_sort | racial differences in inflammation and outcomes of aging among kidney transplant candidates |
| topic | End-stage renal disease Inflammation Race Frailty HRQOL |
| url | http://link.springer.com/article/10.1186/s12882-019-1360-8 |
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