Aim/hypothesis: The relationship between peripheral blood leukocyte telomere length (LTL) and kidney dysfunction, especially in people with hypertension, remains unclear. No clinical study has explored the role of oxidative stress and inflammatory markers in the relationship between LTL and kidney dysfunction. Therefore, we examined the relationship between baseline LTL and albuminuria progression and/or rapid renal function decline in Chinese patients with or without hypertension, and investigated whether oxidative stress and inflammation play a mediating role in this relationship.
Methods: We conducted a prospective study including 262 patients in a 7-year follow-up period from 2014 to 2021. Data on LTL, inflammation, oxidative markers, renal function, and urine protein levels were assessed. Kidney dysfunction was defined as either albuminuria progression, rapid decline in renal function, or the composite endpoint (albuminuria progression and rapid decline in renal function). Logistic regression and simple mediation models were used for the analysis.
Results: In this cohort (mean age, 53.18±11.32 years; follow-up period, 5.97±1.16 years), 43, 22, and 59 patients developed albuminuria progression, rapid renal decline, and the composite endpoint of kidney dysfunction, respectively. Logistic regression analysis showed that each standard deviation decrease in the lower quartile (Q) of baseline LTL was correlated with an increased risk of albuminuria progression (odds ratio [OR]=1.493 [95% confidence interval (CI) 0.985, 2.263], P=0.059; OR=3.307 [95% CI 1.033, 10.586], P=0.044; Q2 vs. Q4); rapid renal function decline (OR=2.402 [95% CI 1.361, 4.239], P=0.002; OR=13.457 [95% CI 1.610, 112.472], P=0.016; Q1 vs. Q4); and the composite endpoint of kidney dysfunction (OR=1.797 [95% CI 1.244, 2.594], P=0.002; OR=4.062 [95% CI 1.426, 11.568], P=0.009; Q1 vs. Q4). Subgroup analyses showed that LTL was inversely associated with albuminuria progression and the composite endpoint of kidney dysfunction in patients with hypertension (OR=5.671 [95% CI 1.203, 26.726], P=0.028; OR=4.223 [95% CI 1.297, 13.753], P=0.017), but not in those without hypertension. The mediating analysis showed that tumor necrosis factor (TNF)-α partly mediated the relationship between LTL and rapid decline in renal function (direct effect: β= –0.6791 [–1.2145, –0.1438]; indirect effect: β= –0.2919 [–0.5190, –0.1177]).
Conclusion: Baseline LTL could independently predict kidney dysfunction at follow-up, especially in participants with hypertension. TNF-α partially mediated the negative association between LTL and kidney dysfunction.