(บทความวิจัย) ความสัมพันธ์ระหว่าง hs-CRP และตัวบ่งชี้ทางชีวภาพทางคลินิกกับความเสี่ยงโรคไตวายเรื้อรังระยะ 1-3 ในผู้สูงอายุที่ไม่มีอาการ

Chutima Rianrakwong; Sanita  Singsanan; Nattaphol  Prakobkaew; Niramon Thamwiriyasati

Authors

Chutima Rianrakwong Master of Science Program in Biomedical Science, Faculty of Allied Health Science, Burapha University, Chonburi Province, Thailand
Sanita Singsanan Division of Medical Technology, Faculty of Allied Health Science, Burapha University, Chonburi Province, Thailand
Nattaphol Prakobkaew Division of Medical Technology, Faculty of Allied Health Science, Burapha University, Chonburi Province, Thailand
Niramon Thamwiriyasati Division of Medical Technology, Faculty of Allied Health Science, Burapha University, Chonburi Province, Thailand

Keywords:

Chronic Kidney Disease (CKD), Glomerular Filtration Rate (GFR), High-sensitivity C-reactive protein, Elderly people

Abstract

Chronic kidney disease (CKD) is a condition characterized by progressive and irreversible damage to kidney tissue lasting for more than three months, leading to a gradual decline in renal function. The diagnosis and staging of CKD typically rely on blood and urine tests, imaging studies, and, in some cases, histopathological examination of kidney biopsy specimens. Key laboratory blood biomarkers include blood urea nitrogen (BUN) and creatinine (Cr); however, these markers have limitations in sensitivity, as their levels tend to change only after substantial kidney damage has already occurred, making early detection challenging. Currently, high-sensitivity C-reactive protein (hs-CRP) has emerged as a useful biomarker for detecting low-grade chronic inflammation, which may reflect early renal deterioration. This study aimed to investigate the association between hs-CRP and clinical biomarkers with the risk of early-stage CKD (stages 1-3) in asymptomatic elderly individuals. The results demonstrated that hs-CRP alone was insufficient to effectively indicate or differentiate the extent of kidney damage across CKD stages when compared with the decline in estimated glomerular filtration rate (eGFR). However, when hs-CRP was combined with BUN or uric acid (Urc), a stronger and consistent association was observed. In particular, hs-CRP showed a statistically significant correlation with uric acid (p < 0.0001). Furthermore, a decrease in eGFR was associated with elevated levels of hs-CRP in combination with BUN and Urc. These findings suggest that the combined use of multiple biomarkers enhances the sensitivity and potential of detecting renal impairment. This approach also supports more accurate monitoring of disease progression and severity. Therefore, integrating multiple biomarkers may improve the diagnosis and prognostic evaluation of CKD, providing clinicians with more comprehensive information for clinical decision-making and treatment planning.

References

Aung TNN, Moolphate S, Koyanagi Y, et al. Determinants of health-related quality of life among community-dwelling Thai older adults in Chiang Mai, Northern Thailand. Risk Manag Health Policy 2022; 15: 1761-74.

Taburee W, Sirilak S, Khotcharrat R, et al. Health-related problems and drivers of health-related quality of life among community-dwelling older adults. J Prim Care Community Health 2020; PMID: 32189548.

Aung TNN, Aung MN, Moolphate S, et al. Thai Older People’s Willingness (Intention) to participate in a care prevention, Community Group Exercise Program: an assessment before Implementing an intervention trial in Chiang Mai, Northern Thailand. Int J Environ Res Public Health 2021; 18: 4044.

Webster AC, Nagler EV, Morton RL, Masson P. Chronic kidney disease. Lancet 2017; 389: 1238-52.

Kriz W, Lemley KV. A potential role for mechanical forces in the detachment of podocytes and the progression of CKD. J Am Soc Nephrol 2015; 26: 258-69.

Rattanacheeworn P, Kerr SJ, Kittanamongkolchai W, et al. Quantification of CYP3A and drug transporters activity in healthy young, healthy elderly and chronic kidney disease elderly patients by a microdose cocktail approach. Front. Pharmacol 2021; 12: 726669.

Cha’on U, Tippayawat P, Sae-Ung N, et al. High prevalence of chronic kidney disease and its related risk factors in rural areas of Northeast Thailand. Sci Rep 2022; 12: 18188.

Castner D. Understanding the stages of chronic kidney disease. Nursing 2010, 40: 24-31.

Fischer A, Schartmann A, Tarantino S, Schuh C, Hiesmayr M. Higher BMI in ICU patients is associated with increased serum creatinine and more frequent renal replacement therapy. Clin Nutr ESPEN 2025; 69: 965-6.

Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130: 461-70.

Bassuk SS, Rifai N, Ridker PM. High-sensitivity C-reactive protein: clinical importance. Curr Probl Cardiol 2004; 29: 439-93.

Yousuf O, Mohanty BD, Martin SS, et al. High-sensitivity C-reactive protein and cardiovascular disease: a resolute belief or an elusive link? J Am Coll Cardiol 2013; 62: 397-408.

Wu Y, Potempa LA, El Kebir D, Filep JG. C-reactive protein and inflammation: conformational changes affect function. Biol Chem 2015; 396: 1181-97.

Ridker PM. High-sensitivity C-reactive protein: potential adjunct for global risk assessment in the primary prevention of cardiovascular disease. Circulation 2001; 103: 1813-8.

Zhang QL, Rothenbacher D. Prevalence of chronic kidney disease in population-base studies systemic review. BMC Public health 2008; 8: 1-8.

Beridze G, Vetrano DL, Marengoni A, Dai L, Carrero J, Calderón-Larrañaga A. Concordance and Discrepancies Among 5 Creatinine-based equations for assessing estimated glomerular filtration rate in older adults. JAMA Network Open 2023; 6: e234211.

Küme T, Sağlam B, Ergon C, Sisman AR. Evaluation and comparison of Abbott Jaffe and enzymatic creatinine methods: Could the old method meet the new requirements? J Clin Lab Anal 2018; 32: 1-8.

Tamakoshi K, Yatsuya H, Kondo T, et al. The metabolic syndrome is associated with elevated circulating C-reactive protein in healthy reference range, a systemic low-grade inflammatory state. Int J Obes 2003; 27: 443-9.

Paffen E, deMaat MPM. C-reactive protein in atherosclerosis: a causal factor? Cardiovasc Res 2006; 71: 30-9.

Kumar SB, Shobharani B. Comparative study of hsCRP in chronic kidney disease. IOSR J Pharm 2015; 5: 8-12.

Johnson RJ, Lozada LS, Lanaspa MA, et al. Uric Acid and Chronic Kidney Disease: Still More to Do. Kidney Int Rep 2023; 8: 229-39.

Haubitz M, Brunkhorst R, Wrenger E, Froese P, Schulze M. Chronic induction of C-reactive protein by haemodialysis, but not by peritoneal dialysis therapy. Perit Dial Int 1996; 16: 158-62.

Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. C-Reactive Protein, Interleukin 6, and Risk of Developing Type 2 Diabetes Mellitus. J Am Med Assoc 2001; 286: 327-34.

Ridker PM. High-sensitivity C-reactive protein: potential adjunct for global risk assessment in the primary prevention of cardiovascular disease. Circulation 2001; 103: 1813-8.