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Serum tryptase concentration and progression to end‐stage renal disease
Author(s) -
Jesky Mark D.,
Stringer Stephanie J.,
Fenton Anthony,
Ng Khai Ping,
Yadav Punit,
Ndumbo Miguel,
McCann Katerina,
Plant Tim,
Dasgupta Indranil,
Harding Stephen J.,
Drayson Mark T.,
Redegeld Frank,
Ferro Charles J.,
Cockwell Paul
Publication year - 2016
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12622
Subject(s) - medicine , tryptase , kidney disease , end stage renal disease , hazard ratio , renal function , proportional hazards model , creatinine , gastroenterology , endocrinology , urology , confidence interval , disease , immunology , mast cell
Background Mast cell activation can lead to nonclassical activation of the Renin–Angiotensin–Aldosterone System. However, the relevance of this to human chronic kidney disease is unknown. We assessed the association between serum tryptase, a product of mast cell activation, and progression to end‐stage renal disease or mortality in patients with advanced chronic kidney disease. We stratified patients by use of angiotensin‐converting enzyme inhibitors/angiotensin receptor II blockers ( ACE i/ ARB ). Materials and methods This was a prospective cohort study of 446 participants recruited into the Renal Impairment in Secondary Care study. Serum tryptase was measured at recruitment by sandwich immunoassay. Cox regression analysis was undertaken to determine variables associated with progression to end‐stage renal disease or death. Results Serum tryptase concentration was independently associated with progression to end‐stage renal disease but not with death. In patients treated with ACE i or ARB , there was a strong independent association between higher tryptase concentrations and progression to end‐stage renal disease; when compared to the lowest tertile, tryptase concentrations in the middle and highest tertiles had hazard ratios [ HR ] of 5·78 (95% confidence interval [ CI ] 1·19–28·03, P = 0·029) and 6·19 (95% CI 1·49–25·69, P = 0·012), respectively. The other independent risk factors for progression to end‐stage renal disease were lower age, male gender, lower estimated glomerular filtration rate and higher urinary albumin creatinine ratio. Conclusion Elevated serum tryptase concentration is an independent prognostic factor for progression to end‐stage renal disease in patients with chronic kidney disease who are receiving treatment with an ACE i or ARB .