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Serum C-reactive protein (CRP) and risk of death in chronic dialysis patients
Insights
High C-reactive protein (CRP) levels predict death in chronic dialysis patients, independent of malnutrition markers like serum albumin. Monitoring CRP is crucial for assessing mortality risk in this population.
Area of Science:
- Nephrology
- Cardiovascular Disease Research
- Biomarker Analysis
Background:
- Chronic dialysis patients face poor prognoses, often linked to cardiovascular disease.
- Malnutrition (hypoalbuminemia) and elevated C-reactive protein (CRP) are known mortality predictors in dialysis patients.
Purpose of the Study:
- To investigate the relationship between C-reactive protein (CRP) and serum albumin concentration.
- To assess the predictive value of baseline CRP for mortality in chronic dialysis patients.
Main Methods:
- A cohort of 163 chronic dialysis patients in Okinawa, Japan, had baseline CRP data collected in 1991.
- Patients were categorized into low CRP (<10 mg/l) and high CRP (>=10 mg/l) groups and followed until 1997.
- Survival analysis utilized Kaplan-Meier curves and Cox proportional hazard models, adjusting for covariates like age, sex, diabetes, serum albumin, and blood pressure.
Main Results:
- Patients with high baseline CRP (group 2) exhibited significantly lower serum albumin levels compared to the low CRP group (group 1).
- The 5-year survival rate was markedly poorer in the high CRP group (44.4%) versus the low CRP group (82.5%).
- High CRP levels were associated with a significantly increased risk of death (relative risk 3.48), independent of other factors.
Conclusions:
- C-reactive protein (CRP) serves as a significant independent predictor of mortality in chronic dialysis patients.
- Elevated CRP levels warrant careful evaluation and monitoring in dialysis patients, even when serum albumin is within the normal range.
Background:
The prognosis of chronic dialysis patients is poor, in part due to the high incidence of cardiovascular disease. Malnutrition, such as hypoalbuminaemia, has been shown to be a predictor of death in this group of patients, while serum C-reactive protein (CRP) is a predictor of myocardial infarction and sudden death. Thus, the aim of the present study was to determine of the relationship between CRP and serum albumin concentration, and the value of baseline CRP data in the prediction of death.
Methods:
In one of the dialysis units in Okinawa, Japan, baseline CRP data was available (n=163, 95 men and 68 women) in January 1991. These patients were divided into two groups according to their baseline CRP levels, with group 1 consisting of CRP<10 mg/l (n=128) and group 2 of CRP> or =10 mg/l (n=35), and then followed up until the end of 1997. Survival curves were calculated using the Kaplan-Meier method. The statistical significance of the relationship between CRP levels and the risk of death was evaluated by multiple logistic analysis with covariables such as age, sex, diabetes mellitus, serum albumin, and blood pressure.
Results:
The mean (SD) level of serum albumin was 38 (3) g/l in group 1 and 36 (3) g/l in group 2 (P<0.00001). The 5-year survival rate was significantly poorer in group 2 (44.4%) than in group 1 (82.5%) (P<0.0001). Furthermore, the risk of death was significantly higher in group 2 (relative risk 3.48 (95% confidence interval 1.76-6.89), P<0.0003) by multivariate Cox proportional hazard analysis.
Conclusions:
CRP is a significant predictor of death in chronic dialysis patients, independent of serum albumin and other possible confounders. Dialysis patients with high CRP levels should be carefully evaluated and monitored regardless of serum albumin concentrations in the normal range.