Evaluation of YKL-40 as a Biomarker of Inflammation and Atherosclerosis in Chronic Kidney Disease Patients

Abstract

Background: Chronic kidney disease (CKD) has been recognized as a leading public health problem worldwide. In Egypt, CKD approximately affects 13% of the adult population, resulting in significant morbidity, mortality, and health care costs. Patients with advanced CKD (stage 3 or more) experience a high rate of cardiovascular complications compared to earlier stages of CKD. Objective: To evaluate serum YKL-40 levels in patients with CKD to assess its value as a biomarker of inflammation and its correlation with carotid intima-media thickness (CIMT) as a predictor for early atherosclerosis. Patients and Methods:  The present study was conducted on fifty subjects divided into 2 groups: group I includes 25 patients with CKD (from stage 1 to stage 5 "pre-dialysis") and group II (control group) includes 25 healthy volunteers. The patients were recruited from Internal Medicine Department and Nephrology Unit, Tanta university hospitals in the period between," August 2020 to September 2021 ". Results: In our study, YKL-40 levels were significantly high in CKD patients(P=0.001). As regards CIMT measurements for the studied cases its median value was 0.90 and1 mm for the right and left carotid respectively. On the other hand, CIMT measurements for the studied volunteers were within the normal range with statistically significant differences between both groups (p=0.001). There is a positive significant correlation between the serum YKL-40 level from the studied cases with each of triglycerides, serum urea, serum creatinine, CRP, ESR, R CIMT, and L CIMT. Systolic blood pressure, triglyceride, cholesterol, LDL, serum urea, serum creatine, e-GFR, ESR, CRP, and YKL-40 were found to be independent predictors for CIMT (P<0.05). Serum YKL-40 is a highly sensitive predictor of atherosclerosis in CKD and its specificity is 74% in CKD cases. Conclusion: Serum YKL-40 was significantly high in CKD patients. YKL-40 could be used as a biomarker for inflammation and early detection of atherosclerosis in patients with CKD, but further studies are needed. YKL-40 is an independent predictor of increased CIMT and early atherosclerosis.  YKL-40 is highly sensitive to increased CIMT.