Serum Polyclonal Immunoglobulin Free Light Chain Levels Predict Mortality in People With Chronic Kidney Disease

Hutchison, Colin A.; Burmeister, Anne; Harding, Stephen; Basnayake, Kolitha; Church, Hannah; Jesky, Mark; White, Katie; Green, Clara E.; Stringer, Stephanie; Bassett, Paul; Ferro, Charles J.; Cockwell, Paul

doi:10.1016/j.mayocp.2014.01.028

Cited by 40 publications

(41 citation statements)

References 27 publications

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“…In a more recent study from a different United Kingdom center, 848 patients with CKD, preserved renal function (mean baseline eGFR=45628 ml/min per 1.73 m 2 ), and a lower degree of proteinuria (mean albumin-to-creatinine ratio =10 mg/mmol) were followed up for a median of 63 months, and high cFLC levels were an independent risk factor for death, with an HR of 2.71 (95% CI, 1.98 to 3.70) (16). Previous studies have reported variable associations between cFLC and nontraditional risk factors for poor outcomes in CKD, including CRP and phosphate (14,16).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported variable associations between cFLC and nontraditional risk factors for poor outcomes in CKD, including CRP and phosphate (14,16). Figure 1.…”

Section: Discussionmentioning

confidence: 99%

“…They all show an association between elevated FLC and mortality (14)(15)(16). However, the predictive strength of this association has not been defined, and there have been no studies of the relationship between cFLC and risk of progression to ESRD as well as mortality in a secondary care cohort comprising patients with stages 3-5 predialysis CKD.…”

Section: Introductionmentioning

confidence: 99%

“…The previous studies of cFLC in patients with moderate to advanced CKD represented relatively small patient numbers and a low prevalence of patients with diabetes (14,15). The largest and most recent study included patients with preserved renal function and did not consider progression of renal failure (16).…”

Section: Introductionmentioning

confidence: 99%

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Association of Serum Ig Free Light Chains with Mortality and ESRD among Patients with Nondialysis-Dependent CKD

Ritchie

Assi²,

Burmeister³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives High levels of serum polyclonal combined Ig free light chains are associated with inflammation and decreased excretory kidney function, and they are an independent risk factor for mortality. Whether combined Ig free light chain predicted mortality and progression to ESRD in a stages 3-5 CKD cohort was assessed.Design, setting, participants, & measurements This was a prospective cohort study of 872 patients with stages 3-5 CKD (nondialysis) recruited into the Chronic Renal Insufficiency Standards Implementation Study. Patients were recruited to the Chronic Renal Insufficiency Standards Implementation Study in an unselected manner from secondary care nephrology clinics between 2004 and 2010. Combined Ig free light chain was measured at recruitment and analyzed by quartiles. The cohort was followed up for a median of 41.4 months (interquartile range =28.3-68.0 months). Cox regression analysis was undertaken to determine the variables associated with mortality and progression to ESRD.Results Combined Ig free light chain quartiles were ,49.4, 49.4-68.8, 68.9-100.7, and .100.7 mg/L. An independent association with death and progression to ESRD was associated with the third and fourth combined Ig free light chain quartiles (quartile 3: death: hazard ratio, 1.49; 95% confidence interval, 1.02 to 2.18; P=0.04; ESRD: hazard ratio, 1.72; 95% confidence interval, 1.0 to 2.97; P=0.05; quartile 4: death: hazard ratio, 1.99; 95% confidence interval, 1.34 to 2.93; P,0.001; ESRD: hazard ratio, 3.73; 95% confidence interval, 2.1 to 6.3; P,0.001). The other independent risk factors were (1) preexisting cardiovascular disease, age .65 years old, and eGFR=15-30 ml/ min per 1.73 m 2 for death and (2) age #65 years old, eGFR,30 ml/min per 1.73 m 2 , urinary protein-to-creatinine ratio .30 mg/mmol, and serum phosphate level .4.65 mg/dl for progression to ESRD.Conclusions An elevated serum combined Ig free light chain level is an independent risk factor for mortality and progression to ESRD in patients with stages 3-5 CKD managed in secondary care.

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Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported variable associations between cFLC and nontraditional risk factors for poor outcomes in CKD, including CRP and phosphate (14,16). Figure 1.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Association of Serum Ig Free Light Chains with Mortality and ESRD among Patients with Nondialysis-Dependent CKD

Ritchie

Assi²,

Burmeister³

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…1 Abnormal concentrations of sFLC may result from a number of clinical situations including reduced renal clearance, or monoclonal plasma cell proliferative disorders. The molecular weight of both of the light chains is $22.5 kDa.…”

Section: Introductionmentioning

confidence: 99%

The association of serum-free light-chain levels with markers of renal function

Erdem¹,

Davran²,

Yılmaz

et al. 2015

Renal Failure

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Background: The kidney is often affected in plasma cell dyscrasias, usually due to the effects of nephrotoxic monoclonal-free light chains. Renal failure due to a monoclonal gammopathy may be detected by the highly sensitive serum-free light-chain (sFLC) ratio yet missed by electrophoretic assays. The aim of this study was to assess sFLC levels in relation to markers of renal function. Methods: Five-hundred thirteen patients were included in this study. sFLC levels were measured by Freelite Õ (The Binding Site Group Ltd, Birmingham, UK) assay using the BNII nephelometer (Siemens Diagnostics, Germany). Kappa/lambda (k/) sFLC ratio was calculated. Serum creatinine levels were analyzed by modified Jaffe method in Cobas 8000 analyser. GFR was estimated by the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation. Patients were assigned to two groups depending on their eGFR values: 60 mL/min/1.73 m

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