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Open Access 01-12-2019 | Research article

Racial differences in inflammation and outcomes of aging among kidney transplant candidates

Authors: 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

Published in: BMC Nephrology | Issue 1/2019

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.

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Title: Racial differences in inflammation and outcomes of aging among kidney transplant candidates
Authors: 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
Publication date: 01-12-2019
Publisher: BioMed Central
Published in: BMC Nephrology / Issue 1/2019
Electronic ISSN: 1471-2369
DOI: https://doi.org/10.1186/s12882-019-1360-8

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