Combined Values of Serum Albumin, C-Reactive Protein and Body Mass Index at Dialysis Initiation Accurately Predicts Long-Term Mortality

Abstract

Background: Protein-energy wasting and chronic inflammation are prevalent in patients with end-stage renal disease (ESRD). We investigated the combination of serum albumin, C-reactive protein (CRP) and body mass index (BMI) at initiation of hemodialysis therapy as a predictor of all-cause and cardiovascular disease (CVD) mortality in Japanese ESRD patients. Methods: A total of 1,228 consecutive Japanese ESRD patients on hemodialysis therapy were enrolled and followed for up to 10 years. Patients were divided into quartiles according to levels of albumin, CRP and BMI. Furthermore, to clarify the joint role of these factors, albumin <3.5 g/dl, CRP >4.0 mg/l and BMI <19.6 were defined as risk factors using receiver operating characteristic analysis; thereafter, patients were divided into groups according to the positive number of these factors. Results: Adjusted hazard ratios (HRs) for lower serum albumin, elevated CRP and lower BMI for 10-year all-cause mortality were 1.97, 3.13 and 2.61, respectively. Regarding the combination of these variables, adjusted HRs for mortality were 2.31, 4.28 and 8.07, respectively, in patients having any one factor, any two factors and all three factors. The C-index for an established risk model with these three positive markers was the most accurate for predicting mortality (0.768), as compared to other models with one or two markers. Similar results were seen for CVD mortality. Conclusions: Serum albumin, CRP and BMI at the start of hemodialysis therapy were able to individually stratify the risk of long-term mortality in ESRD patients. Furthermore, a combination of these variables could more accurately predict mortality.

Clinical outcome after infrapopliteal bypass surgery in chronic hemodialysis patients with critical limb ischemia

“…16 Thus, the declined BMI, as an established marker of PEW and elevated CRP, could consistently predict poor survival in this population. 17,18 We also have reported that elevated CRP levels were associated with a high restenosis rate and death after coronary drug-eluting stenting or with a high amputation rate and death after endovascular therapy in chronic HD patients. 19,20 By the way, serum creatinine or urea nitrogen levels were comparable among quartiles according to CRP levels in our previous study.…”

“…19,20 By the way, serum creatinine or urea nitrogen levels were comparable among quartiles according to CRP levels in our previous study. 18 Thus, the elevated CRP levels do not seems to reflect kidney dysfunction but rather the state of chronic inflammation. In this regard, preoperative comorbid conditions, such as the PEW state or chronic inflammation, should be more carefully observed in this population than in the general population.…”

Targeting Immunity in End-Stage Renal Disease

“…In patients with ESRD, several mediators of inflammation share a link with cardiovascular disease [34,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63] (Table 1). Indeed, this is quite dubious for C reactive protein (CRP), either in terms of mere association or from a pathogenic perspective.…”

“…Indeed, this is quite dubious for C reactive protein (CRP), either in terms of mere association or from a pathogenic perspective. In fact, while in some trials CRP did not merge as a strong independent cardiovascular risk factor (instead of IL-1, IL-6, TNF-α, albumin, and body mass index) [52,53,55,60], the genetic analysis of polymorphisms leading to a gain of function of gene transcription of CRP failed to demonstrate a dose-dependent effect of this marker [64] and a possible causal role. Other biomarkers (sTWEAK, MIC-1, CD4 + CD28-null T-cells, RANKL, pentraxin3, CCR5, GAL-3, myeloperoxidase, Lp-PLA 2 , and sCD14) , have also been linked to cardiovascular risk in ESRD [32,34,45,46,47,48,51,57,61,62,63].…”

Prediction of Cardiovascular Mortality in Functionally Disabled Elderly – A Possible New Score / Kardiovaskularni Mortalitet Kod Funkcionalno Zavisnih Starih Osoba - Mogući Prediktivni Skor

“…Inflammatory markers such as C-reactive protein, interleukin 6 and fibrinogen are all positively correlated with cardiovascular death. In flam mation and malnutrition are related (19), and in many studies they were included toget her in cardiovascular risk scores (malnutrition-inflammationathe rosclerosis (MIA) syndrome, prognostic inflammatory and nutritional index (PINI), etc.) (20,21).…”