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

Abstract

BackgroundThe prognostic values of baseline, longitudinal high-sensitivity C-reactive protein (hs-CRP) and its change over time on mortality in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) remain uncertain.MethodsWe retrospectively studied 1228 consecutive CAPD patients from 2007 to 2012, and followed up through December 2014. Cox regression models were performed to assess the association of hs-CRP on outcomes using serum hs-CRP levels as: (1) stratified by tertile of baseline or longitudinal hs-CRP levels; (2) baseline or longitudinal hs-CRP levels as continuous variables; and (3) categorized by tertile of slopes of hs-CRP change per year for each subject.ResultsHigher baseline hs-CRP levels were not associated with clinical outcomes after adjustment for potential confounders. However, patients with the upper tertile of longitudinal hs-CRP had a nearly twice-fold increased risk of both all-cause and cardiovascular mortality [adjusted hazard ratio (HR) 1.77; (95% CI 1.16–2.70) and 2.08 (1.17–3.71), respectively], as compared with those with lower tertile. Results were similar when baseline or longitudinal hs-CRP was assessed as continuous variable. Additionally, the risk of all-cause and cardiovascular mortality in patients with increased trend in serum hs-CRP levels over time (tertile 3) was significantly higher [adjusted HR 2.48 (1.58–3.87) and 1.99 (1.11–3.56), respectively] when compared to those with relatively stable hs-CRP levels during follow-up period. These associations persisted after excluding subjects with less than 1-year follow up.ConclusionsHigher longitudinal serum hs-CRP levels and its elevated trend over time, but not baseline levels were predictive of worse prognosis among CAPD patients.

Prognostic value of inflammation-based prognostic scores on outcome in patients undergoing continuous ambulatory peritoneal dialysis

“…The strong power for outcome prediction of this score may be attributed to the combined effects of its components. Both markers, CRP and serum albumin, have been demonstrated to be strongly associated with all-cause and CVD mortality in patients on PD [ 9 – 11 , 26 , 27 ]. However, ROC analysis revealed that GPS had the higher value than hypoalbuminemia or increased CRP alone (data not shown), which may indicate a reciprocal interaction between these two factors.…”

“…Among them, systemic inflammation is well recognized for its close relationship to cardiovascular morbidity and mortality [ 8 ]. We and others found that elevated C-reactive protein (CRP) levels, especially its elevated trend over time, could be independently predictive of mortality in PD population [ 9 – 11 ]. Importantly, inflammation drives the development of malnutrition, which may in turn amplify systemic inflammation responses, leading to a vicious cycle [ 12 , 13 ].…”

The physiology of uric acid and the impact of end‐stage kidney disease and dialysis

“…In most studies involving patients receiving HD, elevated serum UA levels were associated with lower mortality; however, some studies reported either increased or no difference in mortality . On the other hand, in studies involving patients receiving PD, high serum UA levels were not associated with higher mortality, although a few studies showed no association …”

“…The relationship between serum concentrations of UA and mortality was evaluated in 14 studies of patients with ESKD receiving HD and five studies of patients with ESKD receiving PD, summarized in Table . In most studies involving patients receiving HD, elevated serum UA levels were associated with lower mortality; however, some studies reported either increased or no difference in mortality .…”

Biomarkers in Cardiorenal Syndromes

“…CRP increases glomerular capillary permeability and glomerular mesangial cell hyperplasia through mediating vasoconstriction, embolism, and inflammation. CRP predicts prognosis and stratifies risk in patients with ESRD [ 26 ].…”