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The predictive value of C-reactive protein in end-stage renal disease: is it clinically significant?

Frank M van der Sande1, Jeroen P Kooman, Karel M L Leunissen

  • 1Division of Internal Medicine and Nephrology, University Hospital Maastricht, Maastricht, The Netherlands. fvs@groupwise.azm.nl

Blood Purification
|March 25, 2006
PubMed

Insights

C-reactive protein (CRP) is linked to cardiovascular disease in dialysis patients, but its predictive value is uncertain when other risk factors are considered. Statins may lower CRP but not cardiovascular mortality in diabetic dialysis patients.

Area of Science:

  • Nephrology
  • Cardiology
  • Clinical Chemistry

Background:

  • Cardiovascular disease (CVD) is the primary cause of mortality in end-stage renal disease (ESRD) patients.
  • Mineral and bone metabolism disturbances and inflammation contribute to heightened CVD risk in ESRD.
  • C-reactive protein (CRP) is a marker of inflammation with a known association with atherosclerosis.

Purpose of the Study:

  • To evaluate the clinical evidence and predictive value of C-reactive protein (CRP) for cardiovascular events in ESRD patients.
  • To investigate the role of CRP as a marker, causative agent, or consequence of atherosclerotic vascular disease in dialysis patients.

Main Methods:

  • Review of existing studies examining the association between CRP and cardiovascular disease in the general and ESRD populations.
  • Analysis of the impact of adjusting for traditional risk factors on the predictive power of CRP.
  • Examination of CRP level variability and the effects of interventions like statins in dialysis patients.

Main Results:

  • A statistical association exists between CRP and CVD, but its predictive power diminishes significantly when adjusted for other risk factors.
  • The precise role of CRP in atherosclerotic vascular disease remains unclear in both general and dialysis populations.
  • CRP levels in dialysis patients are highly variable and influenced by concurrent health issues.
  • Statins can reduce CRP levels in dialysis patients, but do not decrease cardiovascular mortality in diabetic patients undergoing dialysis.

Conclusions:

  • The clinical utility of CRP as an independent predictor of cardiovascular events in ESRD patients is questionable.
  • Further research is needed to clarify the complex relationship between CRP, inflammation, and atherosclerosis in ESRD.
  • Interventions targeting CRP may not translate to reduced cardiovascular mortality in all ESRD subpopulations, particularly diabetic patients.

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