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Published on: October 2, 2020
CRP measurement: does the assay matter in hemodialysis patients?
1Department of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. nada.Kanaan@uclouvain.be
Insights
Conventional C-reactive protein (CRP) assays effectively predict mortality in hemodialysis patients, similar to high-sensitivity tests. This finding supports using inexpensive CRP testing for risk assessment in this population.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Chemistry
Background:
- C-reactive protein (CRP) is a marker for systemic inflammation.
- Elevated CRP predicts cardiovascular events and mortality in the general population and hemodialysis patients.
- High-sensitivity CRP assays (hs-CRP) are commonly used, but conventional assays (c-CRP) may also be effective.
Purpose of the Study:
- To compare the predictive accuracy of conventional CRP assays (c-CRP) versus high-sensitivity CRP assays (hs-CRP) for mortality in hemodialysis patients.
- To determine if inexpensive c-CRP testing can reliably predict mortality in this patient group.
Main Methods:
- Serum CRP levels were measured using both conventional and high-sensitivity assays in 102 prevalent hemodialysis patients in April 2001.
- Mortality was prospectively monitored over a 6-year follow-up period.
Main Results:
- Nearly two-thirds of patients exhibited high CRP levels (> 1 mg/dl) regardless of the assay used.
- Patients with high CRP levels showed significantly lower 6-year survival rates compared to those with low CRP levels, irrespective of the assay.
- Both hs-CRP and c-CRP assays indicated higher cardiovascular mortality in patients with elevated CRP levels.
- An excellent correlation was observed between the results from the conventional and high-sensitivity CRP assays.
Conclusions:
- Conventional CRP assays are a cost-effective and reliable tool for predicting mortality in hemodialysis patients.
- The predictive value of CRP for mortality in hemodialysis patients is comparable between conventional and high-sensitivity assays.
Background:
The serum level of C-reactive protein, an acute-phase marker of systemic inflammation, has been shown to predict cardiovascular events in the general population and cardiovascular and total mortality in hemodialysis patients. High-sensitivity CRP assays (hs-CRP) have been used in numerous studies. We hypothesized that the level of CRP as measured by the conventional assay (c-CRP) would predict mortality in hemodialysis patients with an accuracy similar to that of high-sensitivity assays.
Methods:
In April 2001 CRP serum level was measured with both a conventional and a high-sensitivity assay in 102 prevalent hemodialysis patients. Mortality was prospectively monitored over 6 years.
Results:
49 patients (48%) died during follow-up. With both assays, almost 2/3 of patients had high CRP levels (> 1 mg/dl). Survival at 6 years was significantly lower in patients with high CRP levels, no matter which assay was used (31.5% for patients with high hs-CRP and 27.3% for patients with high c-CRP vs 48.4% for patients with low hs-CRP and 47.1% for patients with low c-CRP). Cardiovascular mortality was also higher in patients with high CRP levels, whatever the type of assay (conventional or high sensitivity) used. The correlation between the two tests was excellent.
Conclusion:
CRP level, measured by a conventional inexpensive assay, is predictive of mortality in hemodialysis patients.
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