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Inflammation and cardiovascular risk in dialysis patients
Christoph Wanner1, Josef Zimmermann, Susanne Schwedler
1Department of Medicine, Division of Nephrology, University Clinic of Würzburg, Germany. c.wanner@medizin.uni-wuerzburg.de
Background:
Chronic inflammation, as evidenced by increased levels of C-reactive protein (CRP), predicts all-cause and cardiovascular mortality in hemodialysis patients in short-term studies. Whether CRP is also predictive in the long-term follow-up is unknown.
Methods:
We conducted a 4-year follow-up of a cross-sectional study in a cohort of 280 stable hemodialysis patients. CRP was determined once at the beginning of the study, and all-cause as well as cardiovascular mortality was monitored prospectively.
Results:
During follow-up, 123 patients (43.9%) had died, mostly from cardiovascular events (58.5%) corresponding to an annual mortality rate of 11%. Overall mortality and cardiovascular mortality were significantly higher in patients with a CRP more than 8 mg/L (73% vs. 39% and 87% vs. 55%, respectively). Multivariate Cox regression analysis demonstrated that age, CRP, and preexisting cardiovascular disease were the most powerful predictors, but the presence of diabetes, albumin, and BMI also remained in the model.
Conclusion:
A single determination of CRP is a powerful indicator of all cause and cardiovascular death even after a follow-up period of 4 years in patients on hemodialysis treatment.