Shorter leukocyte telomere length as an early indicator for chronic kidney disease in hypertensive patients

Objective: Essential hypertension is a major risk factor for incident chronic kidney disease (CKD). This is a main reason for preference of antihypertensive medications that provide some protection against hypertension induced renal damage. Furthermore, there is abundant evidence that hypertension and CKD comorbidity worsens cardiovascular disease prognosis with increased morbidity and mortality. Onset of CKD may not be noticeable until there is evident progressive decline in the estimated glomerular filtration rate (eGFR). For this, telomere attrition may provide some early indication. Telomeres are markers of biological aging, and telomere attrition is associated with oxidative stress and inflammation. Kidney interstitial inflammation is known to play a central role in loss of renal function progressing into CKD. This study investigated the association between telomere length and renal interstitial inflammation in hypertensive patients. Design and Methods: Our study group consisted of 200 participants from the TRANScriptome of renaL humAn TissuE (TRANSLATE) study. Interstitial inflammation in human kidney tissue samples was assessed by histology. eGFR was calculated from serum creatinine using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) FORMULA. Leukocyte telomere length (LTL) was quantified using quantitative polymerase chain reaction. Results: Mean LTL was significantly shorter in hypertensive participants (2.776 ± 0.063) compared with non-hypertensive participants (3.007 ± 0.092; P = 0.041). In hypertensive participants without CKD, renal interstitial inflammation negatively associates with leukocyte telomere length (LTL) (r = -0.483, P = 0.048), and the association remained significant after adjustment for age (r = -0.479, P = 0.041). Similar results were observed after exclusion of patients with eGFR > = 60 ml/min/1.73m 2 . In patients with eGFR < 60 ml/min/1.73m 2 , the association remained significant after adjusting for age, sex, BMI, diabetes mellitus and smoking status (r = -1.429, P = 0.011). These results show that telomere length associates with interstitial inflammation in hypertensive patients with no apparent decrease in eGFR. Conclusions: Hypertensive participants have shorter LTL than non-hypertensive participants, and within the hypertensive group, participants with shorter telomeres are more likely to have CKD. Telomere length may provide suitable indication to help target hypertensive patients at increased risk of developing CKD.