Association of Serum Ig Free Light Chains with Mortality and ESRD among Patients with Nondialysis-Dependent CKD

High levels of serum polyclonal combined Ig free light chains are associated with inflammation and decreased excretory kidney function, and they are an independent risk factor for mortality. Whether combined Ig free light chain predicted mortality and progression to ESRD in a stages 3-5 CKD cohort w...

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Bibliographic Details
Published in:Clinical journal of the American Society of Nephrology 2015-05, Vol.10 (5), p.740-749
Main Authors: Ritchie, James, Assi, Lakhvir K, Burmeister, Anne, Hoefield, Richard, Cockwell, Paul, Kalra, Philip A
Format: Article
Language:English
Subjects:
Age Factors
Aged
Cardiovascular Diseases - complications
Cardiovascular Diseases - mortality
Cause of Death
Creatinine - urine
Disease Progression
Female
Glomerular Filtration Rate
Humans
Immunoglobulin Light Chains - blood
Kidney Failure, Chronic - blood
Kidney Failure, Chronic - etiology
Kidney Failure, Chronic - urine
Male
Middle Aged
Original
Phosphates - blood
Predictive Value of Tests
Prospective Studies
Proteinuria - urine
Renal Insufficiency, Chronic - blood
Renal Insufficiency, Chronic - complications
Renal Insufficiency, Chronic - mortality
Risk Factors
Survival Rate
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Summary:High levels of serum polyclonal combined Ig free light chains are associated with inflammation and decreased excretory kidney function, and they are an independent risk factor for mortality. Whether combined Ig free light chain predicted mortality and progression to ESRD in a stages 3-5 CKD cohort was assessed. This was a prospective cohort study of 872 patients with stages 3-5 CKD (nondialysis) recruited into the Chronic Renal Insufficiency Standards Implementation Study. Patients were recruited to the Chronic Renal Insufficiency Standards Implementation Study in an unselected manner from secondary care nephrology clinics between 2004 and 2010. Combined Ig free light chain was measured at recruitment and analyzed by quartiles. The cohort was followed up for a median of 41.4 months (interquartile range =28.3-68.0 months). Cox regression analysis was undertaken to determine the variables associated with mortality and progression to ESRD. Combined Ig free light chain quartiles were 100.7 mg/L. An independent association with death and progression to ESRD was associated with the third and fourth combined Ig free light chain quartiles (quartile 3: death: hazard ratio, 1.49; 95% confidence interval, 1.02 to 2.18; P=0.04; ESRD: hazard ratio, 1.72; 95% confidence interval, 1.0 to 2.97; P=0.05; quartile 4: death: hazard ratio, 1.99; 95% confidence interval, 1.34 to 2.93; P4.65 mg/dl for progression to ESRD. An elevated serum combined Ig free light chain level is an independent risk factor for mortality and progression to ESRD in patients with stages 3-5 CKD managed in secondary care.
ISSN:1555-9041
1555-905X
DOI:10.2215/CJN.09660914