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C-reactive protein and cardiovascular disease in peritoneal dialysis patients
Didier Ducloux1, Catherine Bresson-Vautrin, Marc Kribs
1Department of Nephrology, Dialysis, and Renal Transplantation, Saint Jacques University Hospital, Besançon, France. dducloux@chu-besancon.fr
Insights
Elevated C-reactive protein (CRP) indicates chronic inflammation and is a significant predictor of cardiovascular events (CVE) and mortality in peritoneal dialysis (PD) patients. Higher CRP levels correlate with increased risk.
Area of Science:
- Nephrology
- Cardiology
- Clinical Chemistry
Background:
- Elevated C-reactive protein (CRP) is a known cardiovascular disease (CVD) risk factor in general and hemodialysis populations.
- The prognostic significance of CRP in peritoneal dialysis (PD) patients remains less understood.
- This study investigates the association between CRP and cardiovascular events (CVE) in PD patients.
Purpose of the Study:
- To determine if C-reactive protein (CRP) levels predict cardiovascular events (CVE) in patients initiating peritoneal dialysis (PD).
- To assess the independent contribution of CRP to CVE risk in the PD population.
- To evaluate CRP as a prognostic marker for mortality in PD patients.
Main Methods:
- Prospective enrollment of 240 patients starting PD.
- Analysis of C-reactive protein (CRP) levels alongside other cardiovascular risk factors.
- Follow-up for a mean of 41 months to record cardiovascular events (CVE) and mortality.
Main Results:
- Patients with higher CRP levels experienced significantly more cardiovascular events (CVE) (27 +/- 14 vs. 6 +/- 8 mg/L; P < 0.0001).
- Elevated CRP was an independent risk factor for CVE; patients in the highest CRP quartile had increased risk.
- Higher CRP levels were also associated with increased mortality risk (P = 0.003).
Conclusions:
- Chronic inflammation, indicated by elevated C-reactive protein (CRP), is prevalent in PD patients.
- CRP is an independent predictor of cardiovascular events (CVE) and mortality in this population.
- Measuring CRP can aid in risk stratification for cardiovascular complications in PD patients.
Background:
Elevated plasma concentrations of C-reactive protein (CRP) is a risk factor for cardiovascular disease (CVD) in the general population and in hemodialysis patients. The prognostic value of CRP is less well known in peritoneal dialysis (PD) patients. We examined the association between CRP and cardiovascular event (CVE) in a large population of PD patients.
Methods:
Two hundred and forty patients starting PD were enrolled in this prospective study. The role of CRP was analyzed with respect to other known cardiovascular risk factors.
Results:
The patients were followed for a mean duration of 41 +/- 21 months; the median value of CRP was 7 mg/L. Eighty-nine cardiovascular events (CVE; 37.1%) occurred in 84 patients and the CRP levels were higher in patients who experienced CVE (27 +/- 14 vs. 6 +/- 8 mg/L; P < 0.0001). In the Cox model, patients in the three lower quartiles of the CRP levels had a decreased risk of CVE compared with those in the highest quartile. Cox regression analysis also revealed that age, a previous history of cardiovascular disease, hyperhomocysteinemia and hypoalbuminemia were risk factors for CVE. CRP levels were higher in patients who died during the study period (25 +/- 12 vs. 5 +/- 8 mg/L; P = 0.003). In the Cox model, patients with CRP levels above the median had an increased risk of death compared with those in the lowest quartile.
Conclusions:
Chronic inflammation, as reflected by elevated CRP levels, is frequent in patients starting PD and independently contributes to an increased incidence of CVE in this population.