C-reactive protein as an outcome predictor for maintenance hemodialysis patients

Owen, William F.; Lowrie, Edmund G.

doi:10.1046/j.1523-1755.1998.00032.x

Cited by 342 publications

(248 citation statements)

References 38 publications

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“…The association between these markers and mortality has been recognized for over a decade and this has been confirmed. [27][28][29] In this multivariate analysis, TA albumin was not associated with mortality for PD patients. Our data showed that the TA albumin decreased as the grade of the Davies index increased.…”

Section: Discussionmentioning

confidence: 59%

Risk Factors for Mortality in Stable Peritoneal Dialysis Patients

et al. 2012

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Background: The mortality rates of end-stage renal disease patients have significantly declined over the past decade. However, there are few reports on the risk factors for mortality in stable peritoneal dialysis (PD) patients who survive for a considerable time. Patients and methods: We reviewed the medical records and identified all adult patients who received PD between April 2001 and March 2009 in our institution. The total cohort was 550 patients. Among these patients, 383 patients were enrolled as stable PD patients. Results: The cumulative survival of the stable PD patients was 91.6% at 3 years and 78.7% at 5 years. On univariate analysis, old age (≥65 years of age), hypoalbuminemia (<35 g/L), log C-reactive protein (CRP) (≥0.84), phosphorus (<1.13 mmol/L), statin, icodextrin, and the Davies index were associated with mortality for all PD patients. Old age, hypoalbuminemia, log CRP, phosphorus, the residual renal function (RRF) (≤4 mL/min/1.73 m 2 ) at 24 months, renin-angiotensin system blockade, icodextrin, and the Davies index were associated with mortality for the stable PD patients. Multivariate analysis showed that, among the variables, age, log CRP, phosphorus, initial RRF, and the Davies index were associated with mortality for all PD patients. In stable PD patients, age, log CRP, phosphorus, RRF at 24 months, and the Davies index were associated with mortality. Conclusion: Initial high RRF combined with the RRF preservation, maintenance of proper phosphorus, control of inflammation, and proper management of comorbidities may help to improve the survival of PD patients including stable PD patients.

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Section: Discussionmentioning

confidence: 59%

Risk Factors for Mortality in Stable Peritoneal Dialysis Patients

et al. 2012

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“…In the past decade, much attention has been focused on CRP as a prototypical marker of inflammation, and elevated levels of CRP are associated with mortality and cardiovascular disease in the CKD population (21,36,38). The lack of association that was seen in our study potentially may be explained by the following observations.…”

Section: Discussionmentioning

confidence: 65%

“…Serum albumin is one of the key indicators of dialysis quality (34). Hypoalbuminemia has been demonstrated to be a strong predictor of death (35,36).…”

Section: Discussionmentioning

confidence: 99%

Severe Periodontitis Is Associated with Low Serum Albumin among Patients on Maintenance Hemodialysis Therapy

Kshirsagar

Craig

Beck

et al. 2007

Clinical Journal of the American Society of Nephrology

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The relationship between periodontitis and two measures of systemic inflammation, serum albumin and C-reactive protein (CRP), were examined among patients who were receiving chronic outpatient hemodialysis. Adult patients at two locations, North Carolina and New York City, were evaluated by dentist examiners. Six sites per tooth (up to 32 teeth per patient) were examined. A periodontitis case was defined as >60% of sites with attachment level >4 mm. Multivariable logistic regression was used to determine the association of periodontitis with low serum albumin, defined as <3.5 mg/dl, and with high CRP, defined as >3.0 mg/dl. A total of 154 patients completed the study. The mean age was 54.6 yr (SD 13.3), and average duration of dialysis was 4.0 yr (3 mo to 16 yr). Eighty-six (54.6%) were men, and 89 (58.2%) were black. Common causes of end-stage kidney disease were hypertension (12.3%), diabetes (22.1%), glomerulonephritis (7.1%), and other (58.4%). The average number of teeth was 20.3 (SD 8.4). Thirty-five (23%) patients were periodontitis cases. Severe periodontitis was associated with low serum albumin (odds ratio 8.20; 95% confidence interval 1.61 to 41.82; P ‫؍‬ 0.01) compared with individuals without severe periodontitis disease after adjustment for age, gender, race, diabetes, hypertension, body mass index, smoking, study site, total cholesterol, serum calcium, serum phosphorus, and normalized protein catabolic rate. There was no observed association of severe periodontitis with CRP. Investigation of the potential contribution of periodontitis to serum albumin and possibly to morbidity and mortality among patients with end-stage kidney disease seems warranted.

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“…Many studies relied on assumptions about the role of inflammation in the modification of nutritional status of chronic hemodialysis patients based on cross-sectional findings (1,17,18,39Ϫ41), but not all them were able to provide clinical evidence supporting this link between PEW and nutritional markers in HD patients (40,41). A few studies have attempted to follow HD patients longitudinally to determine whether nutritional status is associated with inflammation over time.…”

Section: Discussionmentioning

confidence: 99%

IL-6 Levels, Nutritional Status, and Mortality in Prevalent Hemodialysis Patients

Beberashvili

Sinuani

Azar

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The influence of serum IL-6 levels on nutritional status in chronic hemodialysis (HD) patients remains to be elucidated. The present report describes a prospective longitudinal study of IL-6 levels and nutritional parameters to determine whether high IL-6 levels are independently associated with nutritional status over time in a cohort of prevalent hemodialysis patients.Design, setting, participants, & measurements 85 clinically stable hemodialysis patients (37.6% women), with a mean age of 66.5 Ϯ 10.6 years, were studied after exclusion of patients with BMI Ͻ 20 kg/m 2 and/or serum albumin Ͻ35 g/L. IL-6, dietary energy and protein intake, and biochemical markers of nutrition and body composition (anthropometry and bioimpedance analysis) were measured at baseline and at 6, 12, 18, and 24 months following enrollment. Observation of this cohort was continued over 2 additional years.Results IL-6 levels increased with time in both unadjusted (linear estimate: 2.57 Ϯ 0.44 pg/ml per 2 yrs; P ϭ 0.001) and adjusted models (linear estimate: 2.35 Ϯ 0.57 pg/ml per 2 yrs; P ϭ 0.049). Significant reductions of daily energy intake, laboratory markers (albumin, transferrin, cholesterol, creatinine), and body composition (fat mass) with higher IL-6 levels were observed over the duration of the longitudinal observation period. However, none of the studied parameters were associated with changes in IL-6 levels over time (IL-6-by-time interactions were NS). Furthermore, cumulative incidences of survival were correlated with the baseline serum IL-6 levels (P ϭ 0.004 by log-rank test). Finally, for each pg/ml increase in IL-6 level, the hazard ratio for death from all causes was 1.06 (95% CI 1.01 to 1.10) after adjustment for demographic and clinical parameters. ConclusionsOur results suggest that higher serum IL-6 levels are associated with all-cause mortality without additional changes in clinical and laboratory markers of nutritional status in clinically stable HD patients.

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C-reactive protein as an outcome predictor for maintenance hemodialysis patients

Cited by 342 publications

References 38 publications

Risk Factors for Mortality in Stable Peritoneal Dialysis Patients

Risk Factors for Mortality in Stable Peritoneal Dialysis Patients

Severe Periodontitis Is Associated with Low Serum Albumin among Patients on Maintenance Hemodialysis Therapy

IL-6 Levels, Nutritional Status, and Mortality in Prevalent Hemodialysis Patients

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