Environmental Carbon Monoxide Level Is Associated With the Level of High-Sensitivity C-Reactive Protein in Peritoneal Dialysis Patients

Abstract

Inflammation is highly prevalent among peritoneal dialysis (PD) patients. High-sensitivity C-reactive protein (hs-CRP) is the most widely used inflammatory marker in clinical medicine and is correlated with mortality in PD patients. Air pollution is associated with systemic inflammation. The aim of this cross-sectional study was to assess the role of air pollutants and other clinical variables on hs-CRP values in PD patients.We recruited a total of 175 patients who had been undergoing continuous ambulatory PD or automated PD for at least 4 months and regularly followed up. Air pollution levels were recorded by a network of 27 monitoring stations near or in the patients’ living areas throughout Taiwan. The 12-month average concentrations of particulate matter (PM) with an aerodynamic diameter of <10 and <2.5 μm (PM10 and PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) were included.In stepwise linear regression, after adjustment for related factors, white blood cell count (β: 0.27, 95% confidence interval [CI] [0.71, 2.11]) and CO level (β: 0.17, 95% CI [2.5, 21.32]) were positively associated with hs-CRP and serum albumin levels (β: −0.25, 95% CI [−13.69, −3.96]) and normalized protein nitrogen appearance (β: −0.18, 95% CI [−17.7, −2.51]) was negatively associated with hs-CRP. However, serum indoxyl sulfate and p-cresyl sulfate levels were not significantly associated with hs-CRP (P > 0.05).In PD patients, the environmental CO level was positively correlated with hs-CRP level.

CRP, IL‑2 and TNF‑α level in patients with uremia receiving hemodialysis

“…A previous study confirmed that uremia is often accompanied by a chronic inflammatory response (12). We speculated that inflammatory cytokines level may change.…”

“…Previous studies reported that abnormal protein factors in the serum of patients with uremia may be associated with cardiovascular complications, malnutrition and high mortality (10)(11)(12). Furthermore, it was revealed that inflammation was closely associated with uremia occurrence, development and prognosis (13).…”

C-reactive protein (CRP) and long-term air pollution with a focus on ultrafine particles

“…Previous studies examining long-term exposure to O3 and CRP reported negative, non-significant effect estimates (38,43). Both associations were modeled linearly but the authors did not report if they tested the linearity assumption of their dose-response function.…”

Association between gaseous air pollutants and inflammatory, hemostatic and lipid markers in a cohort of midlife women

“…Some studies found CO and carboxyhemoglobin (COHb) (a CO product) were positively associated with hs-CRP (Davutoglu et al 2009; Huang et al 2014). Panasevich et al (2009) observed positive but not significant associations of hs-CRP with long-term exposures to CO, NO 2 and SO 2 up to 30 years, but not for fibrinogen or PAI-1.…”

“…Very few studies have reported an association between ambient gas exposure and lipoproteins (USEPA 2008USEPA 2010USEPA 2016). Evidence about the impact of long-term exposure to these gases on these markers is more scarce and inconsistent (Dadvand et al 2014; Forbes et al 2009; Huang et al 2014; Panasevich et al 2009). More research is needed to provide additional evidence about the relationship between ambient gas exposure and inflammatory, hemostatic and lipid markers to reconcile the available findings.…”