Leukocytosis, hypoalbuminemia, and the risk for chronic kidney disease in US adults

Background. Atherosclerosis and chronic kidney disease (CKD) share several common antecedents. However, the association between inflammatory markers and incident CKD is unknown. Methods: We determined risk for incident CKD, defined by treatment for kidney failure or death related to kidney disease, in 9,250 US adults aged 30 to 74 years who participated in the Second National Health and Nutrition Examination Survey (NHANES 11), a nationally representative prospective cohort study with 17 years of follow-up. Results After adjusting for age, race, sex, blood pressure, smoking, and body mass index, there was a graded positive association with increasing total white blood cell (WBC) count and risk for CKD (P for trend <0.001; relative hazard (RH) highest versus lowest quartile, 2.34; 95% confidence interval [CI], 1.30 to 4.19). This association remained statistically significant after adjusting further for the presence of diabetes and cardiovascular disease at baseline (RH, 2.01; 95% CI, 1.11 to 3.65). A similarly strong and graded association with incident CKD was observed for hypoalbuminemia after adjusting for age, race, sex, blood pressure, smoking, and body mass index (P for trend = 0.02; RH lowest versus highest quartile, 1.91; 95% CI, 0.89 to 4.07) and additionally adjusting for the presence of diabetes and cardiovascular disease at baseline (P for trend = 0.02; RH lowest versus highest, 2.05; 95% CI, 0.96 to 4.39). Conclusion: In a nationally representative sample of US adults, elevated WBC count and hypoalbuminemia were associated with future risk for CKD. These results support the hypothesis that systemic inflammation is an independent risk factor for CKD.