Is a single time point C-reactive protein predictive of outcome in peritoneal dialysis patients?
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AbstractC-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 less than or equal to 1.26 mg/L, 1.27 to 5.54 mg/L, and greater than or equal to 5.55 mg/L. Those with higher hs-CRP were significantly older (P < 0.001), had greater body mass index (P < 0.001), higher prevalence of coronary artery disease (P = 0.003), and greater left ventricular mass index (P < 0.001). One-year overall mortality was 3.9% (lower) versus 8.8% (middle) versus 21.3% (upper tertile) (P < 0.0001). Cardiovascular death rate was 2.7% (lower) versus 5.2% (middle) versus 16.2% (upper tertile) (P < 0.0001). Multivariable Cox regression analysis showed that every I mg/L increase in hs-CRP was independently predictive of higher all-cause mortality (hazard ratio [HR], 1.02; 95% Cl, 1.01 to 1.04; P = 0.002) and cardiovascular mortality (HR, 1.03; 95% Cl, 1.01 to 1.05; P = 0.001) in peritoneal dialysis patients. Other significant predictors for all-cause mortality included age (HR, 1.07; 95% Cl, 1.04 to 1.10), gender (HR, 0.49; 95% Cl, 0.27 to 0.90), atherosclerotic vascular disease (HR, 2.65; 95% Cl, 1.46 to 4.80), left ventricular mass index (HR, 1.01; 95% Cl, 1.00 to 1.01) and residual GFR (HR, 0.53; 95% Cl, 0.38 to 0.75). Age (HR, 1.06; 95% Cl, 1.02 to 1.10), history of heart failure (HR, 3.31; 95% Cl, 1.36 to 8.08), atherosclerotic vascular disease (HR, 3.20; 95% Cl, 1.43 to 7.13), and residual GFR (HR, 0.57; 95% Cl, 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.
All Author(s) ListWang AYM, Woo J, Lam CWK, Wang M, Sea MMM, Lui SF, Li PKT, Sanderson J
Journal nameJournal of the American Society of Nephrology
Year2003
Month7
Day1
Volume Number14
Issue Number7
PublisherLIPPINCOTT WILLIAMS & WILKINS
Pages1871 - 1879
ISSN1046-6673
eISSN1533-3450
LanguagesEnglish-United Kingdom
Web of Science Subject CategoriesUrology & Nephrology; UROLOGY & NEPHROLOGY

Last updated on 2020-03-08 at 03:07