Levels of C-reactive Protein, Soluble P-selectin and Cardiac Troponin I in Chronic Kidney Disease Patients without Renal Replacement Therapy

Abstract

Chronic kidney disease (CKD) is a global public health problem and acute coronary syndrome (ACS) is the major complication that leads to mortality. Mechanisms underlining the complication is atherosclerosis, involving inflammation and platelet activation. The aims of this research were to determine the levels of inflammation, C-reactive protein (CRP); platelet activation, soluble P-selectin (sP-sel) and myocardial injury, cardiac troponin I (cTnI) in CKD patients without renal replacement therapy. Blood samples were collected from 171 CKD patients and the plasma stored at -70oC prior to testing. Analysis of high-sensitivity CRP (hs-CRP) was carried out by using the immunoturbidimetric assay, high-sensitivity cTnI (hs-cTnI) by the chemiluminescence microparticle immunoassay (CMIA) and sP-sel by the enzyme-linked immunosorbent assay (ELISA). The resultants CKD subjects were classified by their eGFR into 3 groups; CKD stage 3a (n = 41), stage 3b (n = 65) and stage 4 (n = 65). It was found that CKD stage 3a, 3b and 4 groups had medians (interquartile range, IQR) of hs-CRP at 1.17 (0.54 - 1.62), 1.84 (0.73 - 5.15) and 2.47 (0.82 - 12.44) mg/L, respectively; sP-sel at 56.73 (49.02 - 65.21),51.02 (40.15 - 63.4) and 47.97 (32.79 - 66.05) ng/mL and hs-cTnI at 6.3 (3.6 - 9.9), 11.7 (5.6- 67.39) and 18.9 (8.4 - 45.6) ng/L, respectively. Statistic tests showed that levels of hs-CRP and hs-cTnI were higher in advanced CKD stages (p = 0.002, and < 0.001, respectively), while sP-sel was lower in CKD stage 4 than in CKD stage 3a (p = 0.016) and 3b (p = 0.183). In addition, CKD stages were positively correlated with hs-CRP and hs-cTnI levels (r = 0.165, p = 0.016,and r = 0.318, p < 0.001, respectively), but negatively correlated with sP-sel significantly(r = -0.188, p = 0.006). In conclusion, the present study revealed the increasing correlations of hs-CRP and hs-cTnI with CKD patients with no renal replacement therapy, reflecting inflammation and myocardial injury in CKD. Further study is needed for application of hs-CRP and hs-cTnI analysis in clinical practice to assess ACS risks.