Persistent elevation of C-reactive protein and ischemic heart disease in patients with continuous ambulatory peritoneal dialysis

Kim, Soon Bae; Min, Won Ki; Lee, Sang Koo; Park, Jung Sik; Hong, Changgi D.; Yang, Won Seok

doi:10.1053/ajkd.2002.30554

Cited by 42 publications

(34 citation statements)

References 16 publications

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“…On the other hand, others reported relative stability of CRP as shown by the high concordance for CRP levels measured at baseline and 6 mo later (15,17,36). Recent study showed that a persistently elevated CRP for more than 6 mo is largely related to the presence of ischemic heart disease or other atherosclerotic complications (37). This is in keeping with our current finding of higher prevalence of ischemic heart disease and atherosclerotic complications as well as increased cardiovascular mortality among patients of the upper tertile.…”

Section: Discussionsupporting

confidence: 90%

Is a Single Time Point C-Reactive Protein Predictive of Outcome in Peritoneal Dialysis Patients?

Wang¹,

Woo²,

Lam³

et al. 2003

Journal of the American Society of Nephrology

172

129

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Abstract. C-reactive protein is the prototype marker of inflammation and has been shown to predict mortality in hemodialysis patients. However, it remains uncertain as to whether a single C-reactive protein level has similar prognostic significance in peritoneal dialysis patients. A single high-sensitivity C-reactive protein (hs-CRP) level was measured in 246 continuous ambulatory peritoneal dialysis patients without active infections at study baseline together with indices of dialysis adequacy, echocardiographic parameters (left ventricular mass index, left ventricular dimensions, and ejection fraction), nutrition markers (serum albumin, dietary intake, and subjective global assessment) and biochemical parameters (hemoglobin, lipids, calcium, and phosphate). The cohort was then followed-up prospectively for a median of 24 mo (range, 2 to 34 mo), and outcomes were studied in relation to these parameters. Fifty-nine patients died (36 from cardiovascular causes) during the follow-up period. The median hs-CRP level was 2.84 mg/L (range, 0.20 to 94.24 mg/L). Patients were stratified into tertiles according to baseline hs-CRP, namely those with hs-CRP Յ 1.26 mg/L, 1.27 to 5.54 mg/L, and Ն 5.55 mg/L. Those with higher hs-CRP were significantly older (P Ͻ 0.001), had greater body mass index (P Ͻ 0.001), higher prevalence of coronary artery disease (P ϭ 0.003), and greater left ventricular mass index (P Ͻ 0.001). One-year overall mortality was 3.9% (lower) versus 8.8% (middle) versus 21.3% (upper tertile) (P Ͻ 0.0001). Cardiovascular death rate was 2.7% (lower) versus 5.2% (middle) versus 16.2% (upper tertile) (P Ͻ 0.0001). Multivariable Cox regression analysis showed that every 1 mg/L increase in hs-CRP was independently predictive of higher all-cause mortality (hazard ratio [HR], 1.02; 95% CI, 1.01 to 1.04; P ϭ 0.002) and cardiovascular mortality (HR, 1.03; 95% CI, 1.01 to 1.05; P ϭ 0.001) in peritoneal dialysis patients. Other significant predictors for all-cause mortality included age (HR, 1.07; 95% CI, 1.04 to 1.10), gender (HR, 0.49; 95% CI, 0.27 to 0.90), atherosclerotic vascular disease (HR, 2.65; 95% CI, 1.46 to 4.80), left ventricular mass index (HR, 1.01; 95% CI, 1.00 to 1.01) and residual GFR (HR, 0.53; 95% CI, 0.38 to 0.75). Age (HR, 1.06; 95% CI, 1.02 to 1.10), history of heart failure (HR, 3.31; 95% CI, 1.36 to 8.08), atherosclerotic vascular disease (HR, 3.20; 95% CI, 1.43 to 7.13), and residual GFR (HR, 0.57; 95% CI, 0.38 to 0.86) were also independently predictive of cardiovascular mortality. In conclusion, a single, random hs-CRP level has significant and independent prognostic value in PD patients.

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Section: Discussionsupporting

confidence: 90%

Is a Single Time Point C-Reactive Protein Predictive of Outcome in Peritoneal Dialysis Patients?

Wang¹,

Woo²,

Lam³

et al. 2003

Journal of the American Society of Nephrology

172

129

View full text Add to dashboard Cite

show abstract

“…An elevated level of CRP, which was a marker of inflammation, was a risk factor for morbidity and mortality in the general population 21 ; and in PD patients, CRP was strongly associated with cardiovascular disease. 22,23 Therefore, we confirm that high levels of CRP in overweight patients are associated with bad outcomes. Ohkuma et al further demonstrated that Lp(a) and CRP levels have an important role in carotid atherosclerosis in PD patients.…”

Section: Resultssupporting

confidence: 70%

Survival Advantage of Normal Weight in Peritoneal Dialysis Patients

et al. 2011

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Introduction: A high body mass index (BMI) is a positive predictor of outcome in hemodialysis. But reports for peritoneal dialysis (PD) have been less numerous. The aim of the present investigation was to study the association between BMI and survival among PD patients and to discuss the main risk factors affecting survival. Materials and methods: A total of 159 patients who received PD from 1 January 2006 to 31 December 2010 at the Department of Nephrology in the Third Affiliated Hospital of Soochow University were enrolled in the study. Blood samples and baseline characteristics of the study cohort were obtained at the start of PD. Patient survival status was recorded through 31 December 2010. Results: Patients were stratified into two groups as normal weight (BMI, 18.5-24.9) and overweight (BMI, 25.0-29.9). KaplanMeier survival curve revealed that the normal weight patients had survival advantage over overweight patients (p < 0.01, by log-rank test). Cox proportional hazard models revealed that BMI, age, diabetes mellitus, coronary vascular disease, congestive heart failure and lipoprotein(a) (Lp(a)) were significant risk factors associated with all-cause mortality (p < 0.05). After adjustment for these covariates, survival was consistently higher for normal weight patients (p < 0.01). Furthermore, the study demonstrated that normal weight patients had lower serum Lp(a) (p < 0.05), C-reactive protein (CRP) (p < 0.05), and peritonitis rate (p < 0.05) compared with overweight patients. Conclusion: The results indicated that normal BMI at the commencement of PD had significant survival advantage in our study. The mechanisms for this might be related to lower cardiovascular risk, less chronic inflammation, and peritonitis prevalence.

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“…Inflammation may mediate the loss of kidney function among subjects with chronic kidney disease [3]. Inflammation has also been associated with increased cardiovascular disease in dialysis patients [4]. …”

Section: Introductionmentioning

confidence: 99%

Serum High-Sensitivity C-Reactive Protein Is Not Increased in Patients with IgA Nephropathy

Baek

Chang²,

Min³

et al. 2007

Nephron Clin Pract

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Background/Aims: The development of renal injury in glomerulonephritis (GN) has been related to systemic inflammatory mediators. We investigated whether serum high-sensitivity C-reactive protein (hs-CRP) is a marker reflecting the inflammatory pathogenesis of primary GN. Methods: We compared serum hs-CRP levels in 192 patients with IgA nephropathy (IgAN), 43 patients with membranous nephropathy (MN), and 25 patients with minimal change disease (MCD) undergoing kidney biopsy and 638 matched controls. Results: There were no differences in hs-CRP levels between controls (median 0.08 mg/dl; range 0.03–1.87 mg/dl) and patients with IgAN (0.08 mg/dl; 0.03–3.13 mg/dl), MN (0.07 mg/dl; 0.03–0.99 mg/dl) or MCD (0.08 mg/dl; 0.03–1.75 mg/dl). In patients with IgAN, hs-CRP levels did not differ according to Haas’ pathological subclasses or subsequent renal outcomes. In the IgAN group, hs-CRP showed positive correlations with IgA, uric acid, systolic blood pressure, BMI and age. Hs-CRP level was significantly higher in male than in female IgAN patients. Serum IgA concentration was the strongest independent correlate with hs-CRP levels, and gender and BMI were also independently associated with hs-CRP. There were no correlations between hs-CRP and markers of disease activity. Conclusion: It is likely that hs-CRP does not closely reflect inflammatory pathogenesis in patients with IgAN, MN and MCD.

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Persistent elevation of C-reactive protein and ischemic heart disease in patients with continuous ambulatory peritoneal dialysis

Cited by 42 publications

References 16 publications

Is a Single Time Point C-Reactive Protein Predictive of Outcome in Peritoneal Dialysis Patients?

Is a Single Time Point C-Reactive Protein Predictive of Outcome in Peritoneal Dialysis Patients?

Survival Advantage of Normal Weight in Peritoneal Dialysis Patients

Serum High-Sensitivity C-Reactive Protein Is Not Increased in Patients with IgA Nephropathy

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