Serum C-Reactive Protein: A Predictor of Mortality in Continuous Ambulatory Peritoneal Dialysis Patients

Abstract

Objective To evaluate the predictive value of a single baseline serum C-reactive protein (sCRP) as a marker of mortality in continuous ambulatory peritoneal dialysis (CAPD) patients. Design A review of prospectively collected data in a 2-year follow-up study. Setting Tertiary medical center. Patients The study included 106 patients who were stable and had been on CAPD for a minimum of 3 months. Main Outcome Measures Patient survival rate was the main outcome measure of this study. Other outcome measures were technique survival rate, peritonitis rate, and hospitalized days. Covariables used in the survival analysis were age, sex, the presence of cardiovascular disease or diabetes mellitus, sCRP, serum albumin, hematocrit, cholesterol, HDL-cholesterol, malnutrition by subjective global assessment (SGA), weekly Kt/V urea, and weekly standardized creatinine clearance (SCCr). Results The 2-year patient survival rate was significantly lower in the increased sCRP group than in the normal sCRP group (66.7% vs 94.1%, p = 0.001), although there was no significant difference in technique failure, peritonitis rate, and hospitalized days between the two groups. By Cox proportional hazards analysis, independent predictors of mortality were: cardiovascular disease (relative risk, RR = 8.96, p < 0.005); increased sCRP level (RR = 1.19, p < 0.05); and high hematocrit (RR = 1.18, p < 0.05). ← Conclusion Serum CRP at enrollment is an independent predictor of 2-year patient survival in CAPD patients.

Platelet‐to‐lymphocyte ratio better predicts inflammation than neutrophil‐to‐lymphocyte ratio in end‐stage renal disease patients

“…14,15 Increased serum levels of CRP, IL-6, and TNF-a have been reported in several studies in HD patients [16][17][18] and PD patients. 19,20 During the last two decades, main importance of chronic inflammation was highlighted with the improvements of defining the pathogenesis of atherosclerosis in this population. 21 Inflamma-tory cytokines mentioned above were found to play a central role in the vicious circle of malnutrition, inflammation, and atherosclerosis syndrome in dialysis patients.…”

Elevated serum interleukin‐18 levels might reflect the high risk of hospitalization in patients on peritoneal dialysis

“…A recent study demonstrated increased IL-18 expression in human atherosclerotic plaques in association with plaque destabilization. 6 In a mouse model, exogenous IL-18 administration increased atherosclerotic lesion size in apolipoprotein E -/mice through release of interferon (IFN)-γ. 24 An in vitro study has shown that IL-18 signalling mediated by IL-18 receptors on endothelial cells or smooth muscle cells induced atherogenesis via IL-6 and IL-8 release, as well as expression of adhesion molecules and matrix metalloproteinase.…”

Effect of statins on chronic inflammation and nutrition status in renal dialysis patients: A systematic review and meta‐analysis

“…2 Since the uraemic inflammation and its relation to CVD were reported first by Stenvinkel in the late 1990s, 3 more and more studies have discovered that chronic inflammation is common among dialysis patients and is an important contributor to morbidity and mortality of CVD in this population. [4][5][6][7][8][9] Protein-energy malnutrition is present in a high proportion of ESRD patients and has been shown to be a strong risk factor for mortality in dialysis patients. [10][11][12] The chronic inflammation and nutrition status in renal dialysis patients can be evaluated by the circulating levels of inflammatory and nutrient biomarkers, such as C-reactive protein (CRP), high sensitivity CRP (hs-CRP), interleukin-6 (IL-6), tumour necrosis factor-a (TNF-a), albumin (Alb) and prealbumin.…”