Kidney Week 2025 Annual Meeting-Inflammation at the Crossroads: Atherosclerotic Cardiovascular Disease and CKD Interactions

Video Transcription

Video Summary

This symposium introduced how systemic inflammation links chronic kidney disease (CKD) with atherosclerotic cardiovascular disease (ASCVD) and highlighted emerging anti-inflammatory therapies. The moderator outlined learning goals and noted that CKD-related inflammation is often driven by NLRP3 inflammasome activation, with multiple trials targeting NLRP3, IL‑1, and IL‑6 pathways in CKD and dialysis populations. Key challenges include enrolling patients based on inflammatory criteria (often hsCRP), selecting patient-centered outcomes, managing dialysis trial dropout, addressing safety concerns, and—if effective—ensuring equitable access given the high cost of monoclonal antibodies.<br /><br />Dr. Raj reviewed the epidemiology and bidirectional CKD–ASCVD relationship: cardiovascular death is more common than progression to ESRD, CKD alters MI presentation, and CVD burden rises as eGFR declines. In the CRIC cohort, ~86% of CKD patients showed evidence of inflammation, increasing with lower eGFR and higher albuminuria. Proposed drivers include gut dysbiosis/endotoxin translocation, immune senescence, autonomic dysregulation, uremic toxins, reduced cytokine clearance, myokines, and modified lipoproteins. He emphasized NLRP3→IL‑1/IL‑18→IL‑6 signaling and pyroptosis as central to kidney fibrosis and atherosclerosis. Inflammation markers predicted faster kidney decline and incident ASCVD; IL‑6 was particularly strong. He argued that in CKD, “residual inflammatory risk” may outweigh residual cholesterol risk, supported by CANTOS subgroup findings.<br /><br />Dr. Mikos focused on therapies: hsCRP is a powerful prognostic marker even on statins (JUPITER and pooled analyses). Low-dose colchicine (0.5 mg) reduced events in chronic coronary disease (LoDoCo2) and gained FDA approval, but is contraindicated in advanced CKD and had a subsequent null trial (CLEAR Synergy). CANTOS proved inflammation reduction (IL‑1β inhibition) lowers events but had infection risk and no CV label. IL‑6 ligand inhibition with ziltivekimab markedly lowers CRP in CKD (RESCUE) and is being tested in outcomes trials (ZEUS; plus ARTEMIS and HERMES). Speakers concluded lifestyle, risk-factor control, and targeted inflammation inhibition—especially IL‑6—may address unmet cardio-kidney risk.

Asset Subtitle

Moderator(s): Kristen Nowak

Presentation(s):

Introduction - Kristen Nowak
The Inflammatory Connection: Mechanisms Driving ASCVD and CKD - Dominic Raj
Innovations in Inflammation Control: Therapeutic Advances for Patients with ASCVD and CKD - Erin Michos

Support is provided by an educational grant from Novo Nordisk.

Meta Tag

Date 11/7/2025

Pathway 1 CKD Non-Dialysis

Session ID 518897

Keywords

systemic inflammation

chronic kidney disease (CKD)

atherosclerotic cardiovascular disease (ASCVD)

NLRP3 inflammasome

interleukin-6 (IL-6)

interleukin-1 beta (IL-1β) inhibition

high-sensitivity C-reactive protein (hsCRP)

colchicine therapy

ziltivekimab

CANTOS trial