Abstract
Background
Plasma kidney injury molecule-1 (KIM-1) is a promising biomarker for cardio-renal diseases, but its associations with vascular calcification (VC) and clinical outcomes in non-dialysis chronic kidney disease (CKD) stages G3 to G5 remain unclear. This study investigated the associations between plasma KIM-1, vascular calcification, and adverse clinical outcomes in this population.
Methods
In a prospective cohort of 221 non-dialysis CKD G3 to G5 patients followed for 1.89 ± 0.96 years, associations between plasma KIM-1 and multiple VC measures-including coronary artery calcification (CAC), thoracic aortic calcification (TAC), abdominal aortic calcification (AAC), carotid artery calcification, and aortic valve calcification (AVC)-were assessed using logistic regression models and reported as odds ratios (ORs) with 95% confidence intervals (CIs). Associations with clinical endpoints, including CKD progression, cardiovascular events, and all-cause mortality, were evaluated using Cox proportional hazards regression models and reported as hazard ratios (HRs) with 95% CIs.
Results
The 221 enrolled patients had a mean age of 51 ± 14 years; 63% were male and 32% had diabetes. Median plasma KIM-1 was 266.10 pg/mL, with significantly higher levels in patients with diabetic kidney disease, glomerular disease, and VC. Elevated KIM-1 was independently associated with severe CAC (OR 32.14, 95% CI 2.36-437.21, p = 0.008) and AAC (OR 2.56, 95% CI 1.01–6.48, p = 0.047) after multivariable adjustment with confounders including estimated glomerular filtration rate (eGFR). Higher KIM-1 was also linked to faster eGFR decline (5.07 vs. 3.12 mL/min/1.73 m²/year, p = 0.046) and in associated with the composite clinical endpoint (HR 1.73, 95%CI 1.05–2.86, p = 0.031).
Conclusion
Elevated plasma KIM-1 was associated with severe coronary artery calcification, abdominal aortic calcification, and adverse clinical outcomes in non-dialysis CKD G3 to G5 patients.
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Abbreviations
- AAC:
-
Abdominal aortic calcification
- ALB:
-
Albumin
- ALP:
-
Alkaline phosphatase
- AVC:
-
Aortic valve calcification
- BMI:
-
Body mass index
- BUN:
-
Blood urea nitrogen
- CKD:
-
Chronic kidney disease
- CAC:
-
Coronary artery calcification
- CT:
-
Computed tomography
- CI:
-
Confidence interval
- cTnT:
-
Cardiac troponin T
- CVD:
-
Cardiovascular disease
- CRP:
-
C-reactive protein
- DKD:
-
Diabetic kidney disease
- DBP:
-
Diastolic blood pressure
- ECG:
-
Electrocardiogram
- ELISA:
-
Enzyme-linked immunosorbent assay
- ESRD:
-
End-stage renal disease
- eGFR:
-
estimated glomerular filtration rate
- EF:
-
Ejection fraction
- FSGS:
-
Focal segmental glomerulosclerosis
- FIB:
-
Fibrinogen
- Hb:
-
Hemoglobin
- HUs:
-
Hounsfield units
- HR:
-
Hazard ratio
- HF:
-
Heart failure
- HDL-c:
-
High density lipid -cholesterol
- iPTH:
-
intact parathyroid hormone
- KIM-1:
-
Kidney injury molecule-1
- LDL-c:
-
Low density lipid -cholesterol
- NT-proBNP:
-
N-terminal pro-B-type natriuretic peptide
- PH:
-
Proportional hazard
- ROC:
-
Receiver operating characteristic
- SBP:
-
Systolic blood pressure
- PLT:
-
Platelet
- TCHO:
-
Total cholesterol
- TG:
-
Triglyceride
- TAC:
-
Thoracic aortic calcification
- VC:
-
Vascular calcification
- WBC:
-
White blood cell
Acknowledgements
We would like to express our sincere gratitude to Naya Huang, Xi Xia, Qiong Wen, Xionghui Chen, Xin Wang, Zhijian Li, and Haiping Mao for providing strong support for this research.
Funding
This work was supported by the Natural Science Foundation of Guangdong Province (Grant nos. 2022A1515010433, 2021A1515010427, and 2023A1515012625), Guangdong Provincial Key Laboratory of Nephrology, and NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University).
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Study approval statement: This study protocol was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Sun Yat-sen University (approval number [2022] 656). The study was conducted in accordance with the principles of the Declaration of Helsinki. Consent to participate statement: Written informed consent was obtained from each enrolled patient.
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Zhu, W., Lai, Z., Ke, X. et al. Elevated plasma kidney injury molecule-1 is independently associated with vascular calcification in non-dialysis chronic kidney disease patients of stage G3 to G5. BMC Nephrol (2026). https://doi.org/10.1186/s12882-026-05476-x
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DOI: https://doi.org/10.1186/s12882-026-05476-x