{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T08:51:04Z","timestamp":1776156664596,"version":"3.50.1"},"reference-count":63,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T00:00:00Z","timestamp":1744243200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Science and ICT (MSIT), Republic of Korea","award":["NRF-2021R1F1A1051955"],"award-info":[{"award-number":["NRF-2021R1F1A1051955"]}]},{"name":"Ministry of Science and ICT (MSIT), Republic of Korea","award":["2022R1F1A1071491"],"award-info":[{"award-number":["2022R1F1A1071491"]}]},{"name":"Institute of Clinical Medicine Research at Yeouido St. Mary\u2019s Hospital, Catholic University of Korea","award":["NRF-2021R1F1A1051955"],"award-info":[{"award-number":["NRF-2021R1F1A1051955"]}]},{"name":"Institute of Clinical Medicine Research at Yeouido St. Mary\u2019s Hospital, Catholic University of Korea","award":["2022R1F1A1071491"],"award-info":[{"award-number":["2022R1F1A1071491"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biomolecules"],"abstract":"<jats:p>Background\/Objectives: Fecal calprotectin (FC) is a biomarker of intestinal inflammation widely used in the assessment of gastrointestinal disorders. However, its role in chronic kidney disease (CKD) remains unclear. Given the growing recognition of the gut\u2013kidney axis in CKD pathophysiology, this study aimed to investigate the association between FC levels, systemic inflammation, renal outcomes, and mortality in CKD patients. Methods: We enrolled a total of 515 CKD patients who underwent fecal calprotectin measurement between 2016 and 2023. After applying the exclusion criteria (inflammatory bowel disease, ongoing renal replacement therapy, or incomplete laboratory data), 260 patients were included in the final analysis and stratified into low-FC (&lt;102 \u03bcg\/g, n = 130) and high-FC (\u2265102 \u03bcg\/g, n = 130) groups based on the median FC value. Factors associated with kidney disease progression and patient survival were analyzed. Results: Patients in the high-FC group (\u2265102 \u03bcg\/g) were significantly older (72.8 \u00b1 14.63 vs. 64.02 \u00b1 18.15 years, p &lt; 0.0001) and had a higher prevalence of diabetes mellitus (55.38% vs. 42.31%, p = 0.0349), heart failure (21.54% vs. 7.69%, p = 0.0016), and history of acute kidney injury (33.85% vs. 18.46%, p = 0.0048). Elevated FC was independently associated with increased mortality risk (hazards ratio [HR] 1.658, 95% confidence interval [CI] 1.034\u20132.658, p = 0.0357) with higher mortality rates (48.36 vs. 18.46 per 100,000 person-years). Subgroup analyses revealed stronger associations between FC and mortality in males (HR 2.160, 95% CI 1.046\u20134.463, p = 0.0375), elderly patients (\u226575 years) (HR 2.122, 95% CI 1.209\u20133.725, p = 0.0088), and non-diabetic patients (HR 2.487, 95% CI 1.141\u20135.421, p = 0.0219). While FC was not significantly associated with end-stage kidney disease (ESKD) progression (odds ratio [OR] 1.289, 95% CI 0.455\u20133.650, p = 0.6323), higher FC levels paradoxically predicted slower estimated glomerular filtration rate (eGFR) decline (OR 2.763, 95% CI 1.139\u20136.699, p = 0.0245). Combined analysis revealed patients with both elevated FC and high-sensitivity C-reactive protein (hs-CRP) had the highest mortality risk (HR 3.504, 95% CI 1.163\u201310.554, p &lt; 0.0001) compared to those with low levels of both markers. Conclusions: FC is a potential prognostic biomarker for mortality in CKD patients, independently of traditional inflammatory markers. Further research is warranted to elucidate the mechanisms underlying its paradoxical relationship with renal outcomes and its potential role in risk stratification and therapeutic targeting in CKD.<\/jats:p>","DOI":"10.3390\/biom15040557","type":"journal-article","created":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T05:28:07Z","timestamp":1744262887000},"page":"557","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Fecal Calprotectin as a Prognostic Biomarker for Mortality and Renal Outcomes in Chronic Kidney Disease"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5869-2734","authenticated-orcid":false,"given":"So Young","family":"Lee","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6096-1263","authenticated-orcid":false,"given":"Kyungdo","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4026-4572","authenticated-orcid":false,"given":"Hyuk-Sang","family":"Kwon","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1282-7876","authenticated-orcid":false,"given":"Eun Sil","family":"Koh","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9886-8339","authenticated-orcid":false,"given":"Sungjin","family":"Chung","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.kisu.2021.11.003","article-title":"Epidemiology of chronic kidney disease: An update 2022","volume":"12","author":"Kovesdy","year":"2022","journal-title":"Kidney Int. 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