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Toxins 2013, 5(11), 2058-2073;

Association between Free Light Chain Levels, and Disease Progression and Mortality in Chronic Kidney Disease

INSERM U1088, UFR de Médecine et Pharmacie, Université de Picardie Jules Verne, Amiens 80054, France
Clinical Research Centre—Division of Clinical Pharmacology, Amiens University Hospital and the Jules Verne University of Picardy, Amiens 80054, France
Division of Pharmacy, Amiens University Hospital, Amiens 80054, France
EXcorLab GmbH, Obemburg 63785, Germany
Nephrology Section, Department of Internal Medicine, University Hospital, Ghent 9000, Belgium
Division of Nephrology, Amiens University Hospital, Amiens 80054, France
Division of Nephrology, Ambroise Paré Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt 92100, France
Author to whom correspondence should be addressed.
Received: 24 September 2013 / Revised: 28 October 2013 / Accepted: 29 October 2013 / Published: 8 November 2013
(This article belongs to the Special Issue Uremic Toxins)
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Immunoglobulin free light chains (FLCs) form part of the middle molecule group of uremic toxins. Accumulation of FLCs has been observed in patients with chronic kidney disease (CKD). The aim of the present study was to measure FLC levels in patients at different CKD stages and to assess putative associations between FLC levels on one hand and biochemical/clinical parameters and mortality on the other. One hundred and forty patients at CKD stages 2-5D were included in the present study. Routine clinical biochemistry assays and assays for FLC kappa (κ) and lambda (λ) and other uremic toxins were performed. Vascular calcification was evaluated using radiological techniques. The enrolled patients were prospectively monitored for mortality. Free light chain κ and λ levels were found to be elevated in CKD patients (especially in those on hemodialysis). Furthermore, FLC κ and λ levels were positively correlated with inflammation, aortic calcification and the levels of various uremic toxins levels. A multivariate linear regression analysis indicated that FLC κ and λ levels were independently associated with CKD stages and β2 microglobulin levels. Elevated FLC κ and λ levels appeared to be associated with mortality. However, this association disappeared after adjustment for a propensity score including age, CKD stage and aortic calcification. In conclusion, our results indicate that FLC κ and λ levels are elevated in CKD patients and are associated with inflammation, vascular calcification and levels of other uremic toxins. The observed link between elevated FLC levels and mortality appears to depend on other well-known factors. View Full-Text
Keywords: uremic toxins; free light chain; chronic kidney disease uremic toxins; free light chain; chronic kidney disease

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Desjardins, L.; Liabeuf, S.; Lenglet, A.; Lemke, H.-D.; Vanholder, R.; Choukroun, G.; Massy, Z.A.; European Uremic Toxin (EUTox) Work Group. Association between Free Light Chain Levels, and Disease Progression and Mortality in Chronic Kidney Disease. Toxins 2013, 5, 2058-2073.

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