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The Interrelationship among Renal Impairment, Inflammatory Markers and Mortality in Elderly Transitional Care Unit Patients

Heif M, Johnson L, Dennis RA, Roberson P, Bopp M, Cook J, Sullivan D. The Interrelationship among Renal Impairment, Inflammatory Markers and Mortality in Elderly Transitional Care Unit Patients. Paper presented at: Gerontological Society of America Annual Scientific Meeting; 2007 Nov 16; San Francisco, CA.


Purpose: To assess the interrelationship between renal function, serum inflammatory markers, and mortality in older patients admitted to a VA transitional care unit. Methods: The results from the first 72 male patients [65 White, 8 Black; average age 80.2 years (range 67-93)] enrolled in an ongoing outcomes study were analyzed. Cystatin-C, Creatinine, bUN, and various inflammatory markers (TNFa, soluble TNF receptors [sTNFr] I and II, sgp130, and IL6) were measured at admission and discharge [average length of stay (LOS) was 32.4 days (range 7-161). Glomerular filtration rate (GFR) was estimated based on Cockcroft-Gault and MDRD formulas. Per prior studies, renal insufficiency was defined as a BUN > 30 mg/dl. Average length of post-discharge follow-up was 243 +- 82 days. Results: During the follow-up period, 10 subjects died. Discharge cystatin C, creatinine, BUN, and calculated GRF were highly intercorrelated. Renal function was inversely correlated with TNFa, sTNFrI and II but not IL6. As in prior studies, renal insufficiency at discharge was found to be predictive of post-discharge mortality by Cox Proportional-Hazards Regression analysis (p < .05). However, when the renal function parameters and the discharge cytokines were included in the Cox analysis, sTNFrI was found to be the strongest predictor of mortality. Conclusions: The results are consistent with the literature that suggests that the kidneys play a significant role in the clearance of TNFa and its soluble receptors I and II. It also confirms prior findings that renal function at hospital discharge is associated with mortality and that impaired renal function leads to disregulated inflammatory response characterized by increased serum TNFa and its soluble receptors. This inflammatory state may account for the higher mortality seen in patients with renal impairment.

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