Chronic kidney disease linked to shorter leukocyte telomere length in meta-analysis

BACKGROUND: Chronic kidney disease (CKD) is becoming a global health concern due to its rising prevalence owing to the complex interplay of environmental, genetic, and epigenetic factors. Leukocyte telomere length (LTL) is a potential indicator of biological age in age-related diseases. Our objective is to investigate the association between LTL and CKD in Pakistani population to systematically synthesize existing evidence by investigating previously reported studies. MATERIAL AND METHODS: We conducted a case-control study ( = 166), aged 18-60 years. Relative LTL was measured using quantitative real-time PCR and expressed as telomere-to-single copy gene (T/S) ratios. Biochemical parameters and estimated glomerular filtration rate (eGFR) were assessed using standard methods. Multivariable linear regression adjusted for demographic and cardiometabolic factors was performed. A meta-analysis (11 studies,  = 24,089) were conducted. RESULTS: Our results revealed significant LTL attrition in CKD patients compared to controls with a moderate effect size. Correlational analysis revealed that LTL positively correlated with eGFR (p-value = 0.038) and negatively correlated with urea and creatinine ( < 0.05). After adjustment for age, sex, body mass index, diabetes, smoking, hypertension, and LDL cholesterol, CKD status remained independently associated with shorter LTL. Meta-analysis demonstrated an overall trend toward shorter telomeres in CKD, although substantial heterogeneity and evidence of small study effects were observed. Subgroup analysis in Asian populations showed a consistent but less robust association. CONCLUSION: LTL is associated with CKD, which may reflect systemic biological aging and disease burden rather than serving as a standalone clinical biomarker. Longitudinal studies are required to clarify causality and population-specific effects.