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Open Access Highly Accessed Research article

Association of kidney function with inflammatory and procoagulant markers in a diverse cohort: A cross-sectional analysis from the Multi-Ethnic Study of Atherosclerosis (MESA)

Christopher Keller12*, Ronit Katz3, Mary Cushman4, Linda F Fried5 and Michael Shlipak2

Author Affiliations

1 Department of Medicine, University of California San Francisco, San Francisco, CA, USA

2 San Francisco Veterans Affairs Medical Center, General Internal Medicine Section, San Francisco, CA, USA

3 Collaborative Health Studies Coordinating Center, University of Washington, Seattle, WA, USA

4 Departments of Medicine and Pathology, University of Vermont, Burlington, VT, USA

5 Renal Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA

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BMC Nephrology 2008, 9:9  doi:10.1186/1471-2369-9-9

Published: 5 August 2008



Prior studies using creatinine-based estimated glomerular filtration rate (eGFR) have found limited associations between kidney function and markers of inflammation. Using eGFR and cystatin C, a novel marker of kidney function, the authors investigated the association of kidney function with multiple biomarkers in a diverse cohort.


The Multi-Ethnic Study of Atherosclerosis consists of 6,814 participants of white, African-American, Hispanic, and Chinese descent, enrolled from 2000–2002 from six U.S. communities. Measurements at the enrollment visit included serum creatinine, cystatin C, and six inflammatory and procoagulant biomarkers. Creatinine-based eGFR was estimated using the four-variable Modification of Diet in Renal Disease equation, and chronic kidney disease was defined by an eGFR < 60 mL/min/1.73 m2.


Adjusted partial correlations between cystatin C and all biomarkers were statistically significant: C-reactive protein (r = 0.08), interleukin-6 (r = 0.16), tumor necrosis factor-α soluble receptor 1 (TNF-αR1; r = 0.75), intercellular adhesion molecule-1 (r = 0.21), fibrinogen (r = 0.14), and factor VIII (r = 0.11; two-sided p < 0.01 for all). In participants without chronic kidney disease, higher creatinine-based eGFR was associated only with higher TNF-αR1 levels.


In a cohort characterized by ethnic diversity, cystatin C was directly associated with multiple procoagulant and inflammatory markers. Creatinine-based eGFR had similar associations with these biomarkers among subjects with chronic kidney disease.