High-Sensitivity C-Reactive Protein Predicts Mortality and Technique Failure in Peritoneal Dialysis Patients

Abstract

IntroductionAn elevated level of serum C-reactive protein (CRP) is widely considered an indicator of an underlying inflammatory disease and a long-term prognostic predictor for dialysis patients. This cross-sectional cohort study was designed to assess the correlation between the level of high-sensitivity CRP (HS-CRP) and the outcome of peritoneal dialysis (PD) patients.MethodsA total of 402 patients were stratified into 3 tertiles (lower, middle, upper) according to serum HS-CRP level and and followed up from October 2009 to September 2011. During follow-up, cardiovascular events, infection episodes, technique failure, and mortality rate were recorded.ResultsDuring the 24-month follow-up, 119 of 402 patients (29.6%) dropped out from PD, including 28 patients (7.0%) who died, 81 patients (20.1%) who switched to hemodialysis, and 10 patients (2.5%) who underwent kidney transplantation. The results of Kaplan–Meier analysis and log-rank test demonstrated a significant difference in the cumulative patient survival rate across the 3 tertiles (the lowest rate in upper tertile). On multivariate Cox regression analysis, only higher HS-CRP level, older age, the presence of diabetes mellitus (DM), lower serum albumin level, and the occurrence of cardiovascular events during follow-up were identified as independent predictors of mortality. Every 1 mg/L increase in HS-CRP level was independently predictive of a 1.4% increase in mortality. Multivariate Cox regression analysis also showed that higher HS-CRP level, the presence of DM, lower hemoglobin level, lower serum albumin level, higher dialysate/plasma creatinine ratio, and the occurrence of infective episodes and cardiovascular events during follow-up were independent predictors of technique failure.ConclusionsThe present study shows the importance of HS-CRP in the prediction of 2-year mortality and technique survival in PD patients independent of age, diabetes, hypoalbuminemia, and the occurrence of cardiovascular events.

Cardiovascular Biomarkers in Chronic Kidney Disease: State of Current Research and Clinical Applicability

“…Of note, the mortality rate was not statistically different between patients with low and intermittently elevated CRP levels. In another prospective observational study of 402 patients receiving peritoneal dialysis the investigators reported a 1.4% increase in mortality for each 1 mg/L increase in hsCRP level after 2 years of follow-up [ 45 ]. There are also conflicting reports on the value of CRP in CKD.…”

Association of baseline, longitudinal serum high-sensitive C-reactive protein and its change with mortality in peritoneal dialysis patients

“…Although there generally was agreement between baseline serum CRP levels with outcomes in PD patients, discordant findings were observed across studies [8–11, 19, 28]. In a prospective study of 50 PD patients from a single center in Australia [28], an elevated CRP level was independently associated with CVD events, but not with all-cause mortality.…”

Stirring the Pot: Can Dietary Modification Alleviate the Burden of CKD?

“…A 2016 meta-analysis of n -3 PUFA intervention trials in HD patients found that CRP was significantly reduced; however, no effects were seen with other inflammatory markers (IL-6 and TNF-alpha) [162]. The conclusion that intervention with n -3 PUFAs are able to lower CRP levels has clinical relevance as serum CRP levels are able to independently predict cardiovascular mortality in patients undergoing haemodialysis [172] or peritoneal dialysis [173]. …”