AWARENESS AND PERCEPTIONS ON THE ROLE OF SYSTEMIC INFLAMMATION AND HIGH-SENSITIVITY C-REACTIVE PROTEIN AS A BIOMARKER IN PATIENTS WITH ASCVD AND CKD AMONG CHINESE NEPHROLOGISTS—SUBGROUP RESULTS FROM SPARK-CVD CHINA

Chronic kidney disease (CKD), highly prevalent in China (8.2%), is an established risk factor for cardiovascular diseases (CVD). Systemic inflammation (SI) is an emerging cardiovascular (CV) risk factor and is known to drive CKD development and progression. Furthermore, CKD and its associated CV risk factors including SI collectively perpetuate and exacerbate inflammatory state, thereby amplifying the risk of CV events and mortality. High-sensitivity C-reactive protein (hsCRP) serves as a biomarker for SI, and its prognostic value for CV events is increasingly recognized by clinical guidelines. However, knowledge is not yet established regarding Chinese nephrologists' clinical awareness and perceptions of SI and the role of hsCRP as a biomarker.

This is a subgroup analysis from a nationwide cross-sectional survey conducted from September to December 2024. Participants included cardiologists and nephrologists from 31 provinces across China mainland, treating at least 20 adult patients with ASCVD and CKD monthly, with over three years of clinical practice experience. Data of nephrologists were analyzed using descriptive statistics in this subgroup analysis.

A total of 300 eligible nephrologists completed the survey. While 38.3% of respondents discussed SI as a CV risk factor, over 90% discussed traditional risk factors such as hypertension. Most respondents agreed that SI impacted the prognosis (76.3%) and progression (67.0%) of CKD. Patients with ASCVD and CKD were the group most at-risk of SI, indicated by 85.7% of respondents, compared with either disease alone. Less than half (41.3%) of respondents considered SI results in the diagnosis of ASCVD and CKD (Figure 1) while the majority (70.0%, n=210) considered the results in the treatment stage and claimed the results influenced their aggressiveness of treating CKD (84.8%). Those not testing/considering SI (n=83) stated the lack of guideline recommendations (44.6%) and available medications for SI (38.6%) as the main reasons. Respondents claimed that limited awareness of SI in ASCVD (42.3%), high risk of CV events and related complications (37.7%), and delays in diagnosis (34.0%) as the top unmet needs in the management of ASCVD and CKD (Figure 2).

hsCRP was mentioned as a test for SI spontaneously by 28.7% of respondents compared with 87.7% in aided choice. 32.0% indicated that hsCRP threshold for SI was a certain value in the range of ≥2mg/L and <3mg/L, and 15.3% stated unsure of the cut-off value. The widespread use for SI diagnosis (37.3%), proven clinical efficacy (32.7%) and current standard of care (SoC) (31.0%) were the top 3 reasons for using hsCRP testing. Top factors for establishing hsCRP as a standard biomarker for SI assessment included proven clinical efficacy (53.7%) and guideline recommendations (37.7%) (Figure 3). The largest satisfaction-importance gap was found regarding the availability of specific treatments to address SI (6.8/10 vs. 7.9/10).

SI was recognized as an independent CV risk factor although less emphasized than conventional risks. SI testing results influenced Chinese nephrologists’ practice. hsCRP was used for testing SI by most respondents, yet awareness of its priority and standard threshold value for SI were heterogeneous. The lack of treatment also presented a clinical gap in testing and addressing SI to improve the outcome of patients with ASCVD and CKD.