Serum polyclonal immunoglobulin free light chain levels predict mortality in people with chronic kidney disease

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

doi:10.1016/j.mayocp.2014.01.028

Serum polyclonal immunoglobulin free light chain levels predict mortality in people with chronic kidney disease

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

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Abstract

OBJECTIVE: To determine whether elevated serum polyclonal free light chain (FLC) levels predict mortality in a population of individuals with chronic kidney disease (CKD).

PATIENTS AND METHODS: From January 2, 2006, through July 31, 2007, we recruited a cohort of 848 people with CKD who were not receiving renal replacement therapy and did not have monoclonal gammopathy. We measured serum kappa FLC and lambda FLC isotype levels to determine combined FLC (cFLC) levels. The cohort was prospectively followed up for a median of 63 months (interquartile range, 0-93 months). Cox regression analysis was performed to determine variables predictive of mortality.

RESULTS: High cFLC levels were an independent risk factor for death (hazard ratio [HR], 2.71; 95% CI, 1.98-3.70; P<.001). Other independent risk factors were age (HR, 1.79; 95% CI, 1.52-2.10; P<.001), South Asian ethnicity (HR, 0.33; 95% CI, 0.14-0.64; P=.02), preexisting cardiovascular disease (HR, 1.59; 95% CI, 1.09-2.31; P=.02), and high-sensitivity C-reactive protein (HR, 1.13; 95% CI, 1.00-1.28; P=.04). Neither estimated glomerular filtration rate nor albuminuria was an independent risk factor for death.

CONCLUSION: High cFLC levels independently predict mortality in people with CKD.

Original language	English
Pages (from-to)	615-622
Number of pages	8
Journal	Mayo Clinic Proceedings
Volume	89
Issue number	5
Early online date	2 May 2014
DOIs	https://doi.org/10.1016/j.mayocp.2014.01.028
Publication status	Published - May 2014

Keywords

Biomarkers/blood
Cause of Death
Comorbidity
England
Female
Glomerular Filtration Rate
Humans
Immunoglobulin Light Chains/blood
Immunoglobulin kappa-Chains/blood
Immunoglobulin lambda-Chains/blood
Kaplan-Meier Estimate
Male
Middle Aged
Prognosis
Prospective Studies
Renal Insufficiency, Chronic/blood
Severity of Illness Index

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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https://doi.org/10.1016/j.mayocp.2014.01.028
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Hutchison, C. A., Burmeister, A., Harding, S. J., Basnayake, K., Church, H., Jesky, M. D., White, K., Green, C. E., Stringer, S. J., Bassett, P., Ferro, C. J., & Cockwell, P. (2014). Serum polyclonal immunoglobulin free light chain levels predict mortality in people with chronic kidney disease. Mayo Clinic Proceedings, 89(5), 615-622. Advance online publication. https://doi.org/10.1016/j.mayocp.2014.01.028

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title = "Serum polyclonal immunoglobulin free light chain levels predict mortality in people with chronic kidney disease",

abstract = "OBJECTIVE: To determine whether elevated serum polyclonal free light chain (FLC) levels predict mortality in a population of individuals with chronic kidney disease (CKD).PATIENTS AND METHODS: From January 2, 2006, through July 31, 2007, we recruited a cohort of 848 people with CKD who were not receiving renal replacement therapy and did not have monoclonal gammopathy. We measured serum kappa FLC and lambda FLC isotype levels to determine combined FLC (cFLC) levels. The cohort was prospectively followed up for a median of 63 months (interquartile range, 0-93 months). Cox regression analysis was performed to determine variables predictive of mortality.RESULTS: High cFLC levels were an independent risk factor for death (hazard ratio [HR], 2.71; 95% CI, 1.98-3.70; P<.001). Other independent risk factors were age (HR, 1.79; 95% CI, 1.52-2.10; P<.001), South Asian ethnicity (HR, 0.33; 95% CI, 0.14-0.64; P=.02), preexisting cardiovascular disease (HR, 1.59; 95% CI, 1.09-2.31; P=.02), and high-sensitivity C-reactive protein (HR, 1.13; 95% CI, 1.00-1.28; P=.04). Neither estimated glomerular filtration rate nor albuminuria was an independent risk factor for death.CONCLUSION: High cFLC levels independently predict mortality in people with CKD.",

keywords = "Biomarkers/blood, Cause of Death, Comorbidity, England, Female, Glomerular Filtration Rate, Humans, Immunoglobulin Light Chains/blood, Immunoglobulin kappa-Chains/blood, Immunoglobulin lambda-Chains/blood, Kaplan-Meier Estimate, Male, Middle Aged, Prognosis, Prospective Studies, Renal Insufficiency, Chronic/blood, Severity of Illness Index",

author = "Hutchison, {Colin A} and Anne Burmeister and Harding, {Stephen J} and Kolitha Basnayake and Hannah Church and Jesky, {Mark D} and Katie White and Green, {Clara E} and Stringer, {Stephanie J} and Paul Bassett and Ferro, {Charles J} and Paul Cockwell",

year = "2014",

month = may,

doi = "10.1016/j.mayocp.2014.01.028",

language = "English",

volume = "89",

pages = "615--622",

journal = "Mayo Clinic Proceedings",

issn = "0025-6196",

publisher = "Elsevier",

number = "5",

}

TY - JOUR

T1 - Serum polyclonal immunoglobulin free light chain levels predict mortality in people with chronic kidney disease

AU - Hutchison, Colin A

AU - Burmeister, Anne

AU - Harding, Stephen J

AU - Basnayake, Kolitha

AU - Church, Hannah

AU - Jesky, Mark D

AU - White, Katie

AU - Green, Clara E

AU - Stringer, Stephanie J

AU - Bassett, Paul

AU - Ferro, Charles J

AU - Cockwell, Paul

PY - 2014/5

Y1 - 2014/5

N2 - OBJECTIVE: To determine whether elevated serum polyclonal free light chain (FLC) levels predict mortality in a population of individuals with chronic kidney disease (CKD).PATIENTS AND METHODS: From January 2, 2006, through July 31, 2007, we recruited a cohort of 848 people with CKD who were not receiving renal replacement therapy and did not have monoclonal gammopathy. We measured serum kappa FLC and lambda FLC isotype levels to determine combined FLC (cFLC) levels. The cohort was prospectively followed up for a median of 63 months (interquartile range, 0-93 months). Cox regression analysis was performed to determine variables predictive of mortality.RESULTS: High cFLC levels were an independent risk factor for death (hazard ratio [HR], 2.71; 95% CI, 1.98-3.70; P<.001). Other independent risk factors were age (HR, 1.79; 95% CI, 1.52-2.10; P<.001), South Asian ethnicity (HR, 0.33; 95% CI, 0.14-0.64; P=.02), preexisting cardiovascular disease (HR, 1.59; 95% CI, 1.09-2.31; P=.02), and high-sensitivity C-reactive protein (HR, 1.13; 95% CI, 1.00-1.28; P=.04). Neither estimated glomerular filtration rate nor albuminuria was an independent risk factor for death.CONCLUSION: High cFLC levels independently predict mortality in people with CKD.

AB - OBJECTIVE: To determine whether elevated serum polyclonal free light chain (FLC) levels predict mortality in a population of individuals with chronic kidney disease (CKD).PATIENTS AND METHODS: From January 2, 2006, through July 31, 2007, we recruited a cohort of 848 people with CKD who were not receiving renal replacement therapy and did not have monoclonal gammopathy. We measured serum kappa FLC and lambda FLC isotype levels to determine combined FLC (cFLC) levels. The cohort was prospectively followed up for a median of 63 months (interquartile range, 0-93 months). Cox regression analysis was performed to determine variables predictive of mortality.RESULTS: High cFLC levels were an independent risk factor for death (hazard ratio [HR], 2.71; 95% CI, 1.98-3.70; P<.001). Other independent risk factors were age (HR, 1.79; 95% CI, 1.52-2.10; P<.001), South Asian ethnicity (HR, 0.33; 95% CI, 0.14-0.64; P=.02), preexisting cardiovascular disease (HR, 1.59; 95% CI, 1.09-2.31; P=.02), and high-sensitivity C-reactive protein (HR, 1.13; 95% CI, 1.00-1.28; P=.04). Neither estimated glomerular filtration rate nor albuminuria was an independent risk factor for death.CONCLUSION: High cFLC levels independently predict mortality in people with CKD.

KW - Biomarkers/blood

KW - Cause of Death

KW - Comorbidity

KW - England

KW - Female

KW - Glomerular Filtration Rate

KW - Humans

KW - Immunoglobulin Light Chains/blood

KW - Immunoglobulin kappa-Chains/blood

KW - Immunoglobulin lambda-Chains/blood

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - Prognosis

KW - Prospective Studies

KW - Renal Insufficiency, Chronic/blood

KW - Severity of Illness Index

U2 - 10.1016/j.mayocp.2014.01.028

DO - 10.1016/j.mayocp.2014.01.028

M3 - Article

C2 - 24797643

SN - 0025-6196

VL - 89

SP - 615

EP - 622

JO - Mayo Clinic Proceedings

JF - Mayo Clinic Proceedings

IS - 5

ER -

Serum polyclonal immunoglobulin free light chain levels predict mortality in people with chronic kidney disease

Abstract

Keywords

UN SDGs

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