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Serum tryptase concentration and progression to end-stage renal disease.

Jesky, Mark D and Stringer, Stephanie J and Fenton, Anthony and Ng, Khai Ping and Yadav, Punit and Ndumbo, Miguel and McCann, Katerina and Plant, Tim and Dasgupta, Indranil and Harding, Stephen J and Drayson, Mark T and Redegeld, Frank and Ferro, Charles J and Cockwell, Paul (2016) Serum tryptase concentration and progression to end-stage renal disease. European journal of clinical investigation, 46 (5). pp. 460-74. ISSN 1365-2362. This article is available to all HEFT staff and students via ASK HEFT Discovery tool http://tinyurl.com/z795c8c using their Athens Login

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Official URL: http://onlinelibrary.wiley.com/doi/10.1111/eci.126...

Abstract

BACKGROUND

Mast cell activation can lead to nonclassical activation of the Renin-Angiotensin-Aldosterone System. However, the relevance of this to human chronic kidney disease is unknown. We assessed the association between serum tryptase, a product of mast cell activation, and progression to end-stage renal disease or mortality in patients with advanced chronic kidney disease. We stratified patients by use of angiotensin-converting enzyme inhibitors/angiotensin receptor II blockers (ACEi/ARB).

MATERIALS AND METHODS

This was a prospective cohort study of 446 participants recruited into the Renal Impairment in Secondary Care study. Serum tryptase was measured at recruitment by sandwich immunoassay. Cox regression analysis was undertaken to determine variables associated with progression to end-stage renal disease or death.

RESULTS

Serum tryptase concentration was independently associated with progression to end-stage renal disease but not with death. In patients treated with ACEi or ARB, there was a strong independent association between higher tryptase concentrations and progression to end-stage renal disease; when compared to the lowest tertile, tryptase concentrations in the middle and highest tertiles had hazard ratios [HR] of 5·78 (95% confidence interval [CI] 1·19-28·03, P = 0·029) and 6·19 (95% CI 1·49-25·69, P = 0·012), respectively. The other independent risk factors for progression to end-stage renal disease were lower age, male gender, lower estimated glomerular filtration rate and higher urinary albumin creatinine ratio.

CONCLUSION

Elevated serum tryptase concentration is an independent prognostic factor for progression to end-stage renal disease in patients with chronic kidney disease who are receiving treatment with an ACEi or ARB.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via ASK HEFT Discovery tool http://tinyurl.com/z795c8c using their Athens Login
Subjects: WJ Urogenital system. Urology
Divisions: Emergency Services > Renal
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Depositing User: Mrs Caroline Tranter
Date Deposited: 03 Feb 2017 12:05
Last Modified: 03 Feb 2017 12:05
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1165

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