C‐reactive Protein: Repeated Measurements will Improve Dialysis Patient Care

Abstract

Systemic inflammation is a common feature in the uremic phenotype and associates with poor outcomes. The awareness regarding the importance of inflammation assessment in chronic kidney disease (CKD) patients has risen in recent years, and despite the development of novel biomarkers, C-reactive protein (CRP) is still the most measured inflammatory parameter. Notwithstanding, the possible weak points of CRP determination, this biomarker has demonstrated being useful both for guidance in clinical practice and for risk estimation. In addition, regular determination of CRP among dialysis patients has been associated with better outcomes in different dialysis facilities. Because persistent inflammation may be a silent reflection of various pathophysiologic alterations in CKD, it is crucial that inflammatory markers are regularly monitored and therapeutic attempts be made to target this inflammation.

Associations among Serum Beta 2 Microglobulin, Malnutrition, Inflammation, and Advanced Cardiovascular Event in Patients with Chronic Kidney Disease

“…Most of the studies demonstrated the association among malnutrition, inflammation, and atherosclerosis syndromes cross‐sectionally because CRP measurements were not repeated regularly . We assessed CRP and components of MIA syndrome annually in CKD subjects as per some authors’ recommendation . In subjects with CKD, we demonstrated that the high baseline serum B2M was associated with death, death or dialysis, and CVEs, as well as the occurrence of MIA syndrome.…”

Serum albumin, inflammation, and nutrition in end‐stage renal disease: C‐reactive protein is needed for optimal assessment

“…Persistent inflammation, usually assessed by C‐reactive protein (CRP) levels, is a characteristic feature in advanced chronic kidney disease (CKD). It is caused by multiple factors linked to the toxic uremic milieu, senescence and even the dialysis technique itself . Persistent inflammation contributes to decreased S‐Alb levels, promotes a prematurely aged phenotype, and plays a central role in the Malnutrition, Inflammation and Atherosclerosis (MIA) syndrome, which predicts poor clinical outcomes .…”

“…Persistent inflammation contributes to decreased S‐Alb levels, promotes a prematurely aged phenotype, and plays a central role in the Malnutrition, Inflammation and Atherosclerosis (MIA) syndrome, which predicts poor clinical outcomes . Because there is no consensus regarding the appropriate cutoff concentration for CRP in CKD, it has been problematic to ascertain and understand the magnitude, variability, and consequences of uremic inflammation . Moreover, according to the inflammation‐catalyst hypothesis, persistent inflammation modifies the risk factor profile and exacerbates the effects of a range of prevalent risk factors in CKD .…”

“…Thus, the variation of CRP in dialysis patients is three orders of magnitude higher as compared to S‐Alb variation because of the much greater range of serum concentrations that occur biologically for CRP . As S‐Alb has a long half‐life, a single measurement of S‐Alb is likely to reflect a prolonged period of sustained inflammation, whereas CRP and cytokines, such as IL‐1 and IL‐6, are rapidly “moving targets” influenced by sudden changes in the highly variable uremic milieu …”

Cardiovascular Risk Factors in End-Stage Renal Disease Patients: The Impact of Conventional Dialysis versus Online-Hemodiafiltration

“…Actually, it was recently recommended to monitor inflammation through the evaluation of inflammatory markers in CKD patients, since persistent inflammation may be a silent reflection of pathophysiologic disturbances [33]. CRP seems to be the most useful biomarker in clinical practice for guidance of inflammation and to estimate risk in CKD patients [33].…”