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Serum amyloid-A rather than C-reactive protein is a better predictor of mortality in hemodialysis patients

Sanja Simic-Ogrizovic1, Violeta Dopsaj, Natasa Bogavac-Stanojevic

  • 1Nephrology Clinic, Clinical Center of Serbia, Belgrade, Serbia. dst@Eunet.yu

The Tohoku Journal of Experimental Medicine
|September 25, 2009
PubMed

Insights

Chronic inflammation is prevalent in hemodialysis patients. Serum amyloid-A (SAA) emerged as the strongest predictor of mortality, outperforming other acute phase proteins and clinical factors.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Inflammation Research

Background:

  • Cardiovascular disease is the leading cause of death in hemodialysis patients.
  • Chronic inflammation is a known risk factor for mortality in this population.
  • C-reactive protein (CRP) and other acute phase proteins are investigated as mortality predictors.

Purpose of the Study:

  • To determine the prevalence of chronic inflammation in hemodialysis patients.
  • To evaluate the role of acute phase proteins, lipids, and divalent ions in predicting mortality.
  • To identify the most effective predictor of mortality in end-stage renal disease patients on hemodialysis.

Main Methods:

  • Prospective 36-month follow-up study of 130 hemodialysis patients.
  • Chronic inflammation defined by serum levels of high-sensitive CRP and serum amyloid-A (SAA).
  • Analysis included positive acute phase proteins (CRP, SAA) and negative acute phase proteins (albumin, fetuin-A), lipids, and divalent ions.

Main Results:

  • The prevalence of chronic inflammation was 35.4%.
  • During follow-up, 18.5% of patients died.
  • Multivariate analysis identified hyperphosphatemia, hypoalbuminemia, and high SAA as independent predictors of mortality.

Conclusions:

  • Serum amyloid-A (SAA) is a strong predictor of mortality in hemodialysis patients.
  • SAA assays are widely available, making SAA a practical tool for outcome prediction.
  • SAA is proposed as the best predictor for end-stage renal disease patient outcomes.

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