C-Reactive Protein and Prediction of 1-Year Mortality in Prevalent Hemodialysis Patients

Abstract

SummaryBackground and objectives Measurement of C-reactive protein (CRP) levels remains uncommon in North America, although it is now routine in many countries. Using Dialysis Outcomes and Practice Patterns Study data, our primary aim was to evaluate the value of CRP for predicting mortality when measured along with other common inflammatory biomarkers.Design, setting, participants, & measurements We studied 5061 prevalent hemodialysis patients from 2005 to 2008 in 140 facilities routinely measuring CRP in 10 countries. The association of CRP with mortality was evaluated using Cox regression. Prediction of 1-year mortality was assessed in logistic regression models with differing adjustment variables.Results Median baseline CRP was lower in Japan (1.0 mg/L) than other countries (6.0 mg/L). CRP was positively, monotonically associated with mortality. No threshold below which mortality rate leveled off was identified. In prediction models, CRP performance was comparable with albumin and exceeded ferritin and white blood cell (WBC) count based on measures of model discrimination (c-statistics, net reclassification improvement [NRI]) and global model fit (generalized R 2 ). The primary analysis included age, gender, diabetes, catheter use, and the four inflammatory markers (omitting one at a time). Specifying NRI Ն5% as appropriate reclassification of predicted mortality risk, NRI for CRP was 12.8% compared with 10.3% for albumin, 0.8% for ferritin, and Ͻ0.1% for WBC. ConclusionsThese findings demonstrate the value of measuring CRP in addition to standard inflammatory biomarkers to improve mortality prediction in hemodialysis patients. Future studies are indicated to identify interventions that lower CRP and to identify whether they improve clinical outcomes.

Multimarker Approach to Risk Stratification for Long-Term Mortality in Patients on Chronic Hemodialysis

“…14 Furthermore, a large international study of HD patients demonstrated that CRP improved the 1-year mortality prediction. 15 The 3 biomarkers (TnT, BNP, and CRP) individually assess different pathophysiological pathways (ie, myocardial injury, left ventricular wall stress, and inflammation, respectively); moreover, they are readily measured, easily accessible, relatively inexpensive, and reproducible. 16 We prospectively investigated whether the combined use of these biomarkers could improve the prediction of long-term mortality in HD patients.…”

Dialysis Outcomes and Practice Patterns Study (DOPPS)

“…Postdialysis electrolyte levels are measured often in many countries; serum fibrinogen, Btype natriuretic peptide, and troponin levels are common in a few countries. Our large longitudinal database of CRP levels formed the basis for a recent publication describing the range of CRP levels in routine dialysis practice, as well as the added prognostic information gained by CRP even when measured along with inflammatory markers relied on in the United States such as serum albumin and ferritin levels (5). Future analysis will evaluate whether physician responses to elevated CRP levels help to improve clinical outcomes.…”

Kronik Böbrek Hastalığında Renal İnflamasyon ve Bazı Güncel Diyet Bileşenleri İlişkisi

“…Yaklaşık 5000 hemodiyaliz hastası ile yapılmış bir çalışmada CRP düzeyi ile mortalite pozitif olarak ilişkili bulunmuştur. Bu nedenle CRP'nin özellikle hemodiyaliz tedavisi alan hastalarda takip edilmesi gereken standart bir biyokimyasal parametre olması gerektiği öne sürülmüştür (34). Son evre böbrek yetmezliği olan hastalarda IL-6'nın mortalite ve KVH'nın tahmin edilmesinde en önemli inflamatuvar belirteç olduğu gösterilmiştir (35).…”