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Creatine Kinase and Mortality in Peritoneal Dialysis
Xianfeng Wu1,2, Lei Zhou3, Xiaojiang Zhan4
1Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Frontiers in Cardiovascular Medicine
|May 27, 2022
Summary
Serum creatine kinase levels before starting peritoneal dialysis (PD) show a U-shaped association with mortality. Both high and low levels increase risks for all-cause and cardiovascular deaths in PD patients.
Area of Science:
- Nephrology and Cardiovascular Research
- Biomarkers in Chronic Kidney Disease
Background:
- The prognostic significance of serum creatine kinase (CK) in patients undergoing peritoneal dialysis (PD) is not well-established.
- Understanding CK's role may offer insights into mortality risks in this patient population.
Purpose of the Study:
- To investigate the association between pre-dialysis serum creatine kinase levels and mortality outcomes in incident PD patients.
- To determine if serum CK levels predict all-cause and cardiovascular mortality in patients initiating PD.
Main Methods:
- Retrospective analysis of 3,446 incident PD patients from five Chinese PD centers (2005-2020).
- Serum CK levels were measured one week prior to PD initiation.
- Cox proportional hazards models were used to assess the association between CK levels and mortality.
Main Results:
- A U-shaped association was observed between serum CK levels and mortality.
- Elevated CK (>179 IU/L) was linked to increased risks of all-cause (HR 1.72) and cardiovascular mortality (HR 1.44).
- Low CK (<111 IU/L) was also associated with higher risks of all-cause (HR 1.40) and cardiovascular mortality (HR 1.45).
- An interaction between CK levels and hyperlipidemia status was noted (p=0.034).
Conclusions:
- Serum creatine kinase levels between 111-179 IU/L before starting PD are associated with a lower risk of death.
- Both higher and lower serum CK levels indicate an increased risk of mortality, suggesting a U-shaped relationship.
- Pre-dialysis serum CK may serve as a prognostic biomarker in patients initiating peritoneal dialysis.
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