C-reactive protein predicts ischaemic stroke in haemodialysis patients

Dialysis patients have a higher incidence of cerebrovascular events compared with the general population. However, the value of C-reactive protein (CRP) in predicting stroke in chronic haemodialysis patients is unknown. The aim of this study was to determine the association between serum CRP levels and ischaemic stoke in chronic haemodialysis patients. We retrospectively reviewed 391 chronic haemodialysis patients between November 2001 and November 2004. Patients who developed acute ischaemic stroke within 36-month were recorded. Patients who had lacunar infarction discovered accidentally during brain computed tomography or magnetic resonance imaging scans were recorded for subgroup analysis. The relation of predialysis serum CRP levels, measured via the nephelometric method, to the development of acute ischaemic stroke was analysed using Kaplan-Meier analysis. Factors related to lacunar infarctions were analysed by multivariate logistic regression. Of the 391 patients, 21 developed acute stroke and 24 had lacunar infarction. Kaplan-Meier analysis showed that patients with a serum CRP > 0.8 mg/dl were at risk of developing acute infarction (p = 0.002). In the Cox regression model adjusted for age, cardiovascular disease, hypertension and diabetes, patients with serum CRP > 0.8 mg/dl are at risk of developing acute ischaemic stroke (p = 0.03). In multivariate logistic regression with adjusted for age, hypertension and diabetes, serum CRP levels significantly associated with lacunar infarction (p = 0.05). Serum CRP levels, independent of cardiovascular disease, age, hypertension and diabetes, are associated with the development of acute ischaemic stroke and lacunar infarct in chronic haemodialysis patients.