Systemic Inflammation Tied to Worse Outcomes in CKD, AMI

Chronic systemic inflammation has long been recognized as a driver of cardiovascular disease, but it may also silently accelerate organ damage and recurrent cardiac events in patients who already carry a heavy disease burden, according to new research presented at the AMCP Annual Meeting 2026 in Nashville, Tennessee.

Two posters offered fresh data on the impact of chronic systemic inflammation, with implications for how clinicians and payers identify and manage high-risk patients across 2 of the most prevalent and costly conditions in the US: chronic kidney disease (CKD) and acute myocardial infarction (AMI).

Both studies used high-sensitivity C-reactive protein (hsCRP) as their biomarker of systemic inflammation. They independently found that patients with elevated levels (defined as hsCRP of ≥ 2 mg/L, but below the threshold associated with acute infection) faced meaningfully worse outcomes than patients without systemic inflammation, even after adjustment for a broad range of comorbidities and medications. Together, the findings underscore the potential value of routine hsCRP testing as a risk stratification tool across cardiovascular and renal care settings.

Systemic Inflammation and CKD Progression in Veterans With ASCVD

The first study, conducted by researchers at the David Geffen School of Medicine at UCLA, Stanford University, and the Palo Alto Veterans Affairs Healthcare System, examined the relationship between systemic inflammation and kidney disease progression in a large cohort of US veterans with both CKD and atherosclerotic cardiovascular disease (ASCVD).¹

Using data from the Veterans Health Administration database from 2008 to 2022, the investigators identified 69,103 veterans with outpatient hsCRP measurements with CKD (3148 with CKD stage 1/2 with albuminuria, 60,874 with CKD stage 3, and 5081 with CKD stage 4). The mean age of participants was 73 years, and the majority had stage 3 CKD. Patients with hsCRP above 10 mg/L were excluded to focus on chronic, low-grade inflammation.

The patients were categorized as having systemic inflammation if their hsCRP fell between 2 and 10 mg/L. Anyone with hsCRP below 2 mg/L was categorized as being without systemic inflammation. CKD worsening was defined as estimated glomerular filtration rate (eGFR) stage worsening, initiation of dialysis, or kidney transplant.

Over a median follow-up of 3.6 years, the incidence of CKD progression was 4.6 events per 100 patient-years among those with systemic inflammation, compared with 3.8 per 100 patient-years among those without (P < .01). After adjusting for demographics, comorbidities, and relevant medications, systemic inflammation was associated with an increased risk of CKD progression (HR, 1.12; 95% CI, 1.08-1.17), kidney failure (HR, 1.09; 95% CI, 1.04-1.15), and sustained eGFR reduction (HR, 1.16; 95% CI, 1.11-1.21).

The authors concluded that hsCRP could serve as an actionable identifier of veterans with CKD and ASCVD who are at elevated risk for adverse kidney outcomes and called for further study into whether targeted anti-inflammatory strategies could slow disease progression in this population.

Systemic Inflammation and Cardiovascular Risk After Heart Attack

The second study, presented by researchers from Novo Nordisk, Komodo Health, and Johns Hopkins Medicine, evaluated whether chronic systemic inflammation independently predicts subsequent major adverse cardiovascular events (MACE) and incident heart failure (HF) for patients hospitalized for a type 1 AMI.²

Using the Komodo Healthcare Map database, investigators identified 3149 adults with a mean age of 61 years who were hospitalized for type 1 AMI between July 2016 and December 2023 who had valid hsCRP measurements. Among them, 46.4% had systemic inflammation. Patients with systemic inflammation were more likely to be female and had higher rates of hypertension, dyslipidemia, and diabetes compared with those without.

Over a mean follow-up of approximately 31 months, the incidence rate of 3-point MACE (nonfatal MI, nonfatal stroke, and all-cause mortality) was 45.4 per 1000 person-years (95% CI, 38.6-53.0) in the systemic inflammation group vs 27.3 per 1000 person-years (95% CI, 22.5-32.7) among those without.

After adjusting for baseline characteristics, systemic inflammation was associated with a 39% higher risk of 3-point MACE (HR, 1.39; 95% CI, 1.08-1.78). Among patients without a prior HF diagnosis, systemic inflammation was associated with a more than twofold increase in the risk of HF hospitalization.

“The increased risks of 3-point MACE and HF hospitalization among patients with AMI and [systemic inflammation] suggest substantial unmet clinical needs within this population,” the researchers wrote.

References

1. Sandhu AT, Furst A, Chang TI, et al. Systemic inflammation is associated with chronic kidney disease progression among those with comorbid atherosclerotic cardiovascular disease: insights from the Veterans Affairs Healthcare System. Presented at: AMCP; April 13-16; Nashville, Tennessee. Poster 47.

2. Nguyen C, Ackermann AM, Marieb E, et al. Systemic inflammation and its association with major adverse cardiovascular events in patients with acute myocardial infarction. Presented at: AMCP; April 13-16; Nashville, Tennessee. Poster 31.