The Role of Inflammation and High-Sensitivity C-Reactive Protein in Atherosclerotic Cardiovascular Disease and Chronic Kidney Disease: The FLAME-ASCVD Survey among Nephrologists.

Abstract

Background: Systemic inflammation (SI) contributes to increased cardiovascular risk in patients with atherosclerotic cardiovascular disease (ASCVD) and chronic kidney disease (CKD). We assessed clinical perceptions toward SI and usage of high-sensitivity C-reactive protein (hsCRP) among nephrologists.

Methods: FLAME-ASCVD Nephro was an online survey of nephrologists from 10 countries who treat ≥20 patients with ASCVD and CKD a month and were practicing for ≥3 years. Results were analyzed using descriptive statistics.

Results: Of 513 nephrologists who responded, 300 completed and were included in the survey; the mean age was 46 years and the mean time in practice was 16 years. Hypertension (89%), overweight/obesity (81%), and CKD (80%) were the ASCVD risk factors most often discussed with patients (SI was ninth). The most common unmet needs (ranked 1-3) for patients with ASCVD and CKD were "lack of effective SI treatment options" (44%), "limited awareness of the role of SI in ASCVD" (35%), and "higher risk of CV events" (33%). Seventy-four percent of nephrologists wanted to learn more about the role of SI in ASCVD and 71% test for and use SI results when determining management approaches. Seventy percent of nephrologists considered hsCRP testing in patients with ASCVD and CKD (aided), and proven clinical efficacy of hsCRP was the top reason (37%); out-of-pocket cost (30%) was the most common reason for not considering hsCRP testing.

Conclusion: Lack of effective treatment options for SI remains the most common unmet need for patients with ASCVD and CKD. Further medical education is needed to raise awareness among nephrologists about the role of SI and hsCRP testing.