High-sensitivity C-reactive protein predicts mortality and technique failure in peritoneal dialysis patients

• Published in: PloS one Vol. 9; no. 3; p. e93063
• Main Authors: Liu, Shou-Hsuan, Li, Yi-Jung, Wu, Hsin-Hsu, Lee, Cheng-Chia, Lin, Chan-Yu, Weng, Cheng-Hao, Chen, Yung-Chang, Chang, Ming-Yang, Hsu, Hsiang-Hao, Fang, Ji-Tseng, Hung, Cheng-Chieh, Yang, Chih-Wei, Tian, Ya-Chung
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 25.03.2014; Public Library of Science (PLoS)
• Subjects: Adult; Albumin; Analysis; Biology and Life Sciences; C-reactive protein; C-Reactive Protein - metabolism; Cardiovascular Diseases - complications; Cohort Studies; Correlation analysis; Creatinine; Cross-Sectional Studies; Diabetes; Diabetes mellitus; Dialysis; Epidemiology; Failure; Female; Follow-Up Studies; Glucose; Hemodialysis; Hemoglobin; Hemoglobins; Hospitals; Humans; Infection; Infection - complications; Inflammation; Kaplan-Meier Estimate; Kidney transplantation; Male; Medical research; Medicine; Medicine and Health Sciences; Methods; Middle Aged; Mortality; Nephrology; Patient outcomes; Patients; Peritoneal dialysis; Peritoneal Dialysis - adverse effects; Peritoneal Dialysis - mortality; Peritoneum; Predictions; Prognosis; Proteins; Regression Analysis; Research and Analysis Methods; Review boards; Sensitivity; Sensitivity analysis; Serum albumin; Studies; Survival; Tao Yuan; Transplantation; Treatment Failure; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0093063

An elevated level of serum C-reactive protein (CRP) is widely considered an indicator of an underlying inflammatory disease and a long-term prognostic predictor for dialysis patients. This cross-sectional cohort study was designed to assess the correlation between the level of high-sensitivity CRP (HS-CRP) and the outcome of peritoneal dialysis (PD) patients. A total of 402 patients were stratified into 3 tertiles (lower, middle, upper) according to serum HS-CRP level and and followed up from October 2009 to September 2011. During follow-up, cardiovascular events, infection episodes, technique failure, and mortality rate were recorded. During the 24-month follow-up, 119 of 402 patients (29.6%) dropped out from PD, including 28 patients (7.0%) who died, 81 patients (20.1%) who switched to hemodialysis, and 10 patients (2.5%) who underwent kidney transplantation. The results of Kaplan-Meier analysis and log-rank test demonstrated a significant difference in the cumulative patient survival rate across the 3 tertiles (the lowest rate in upper tertile). On multivariate Cox regression analysis, only higher HS-CRP level, older age, the presence of diabetes mellitus (DM), lower serum albumin level, and the occurrence of cardiovascular events during follow-up were identified as independent predictors of mortality. Every 1 mg/L increase in HS-CRP level was independently predictive of a 1.4% increase in mortality. Multivariate Cox regression analysis also showed that higher HS-CRP level, the presence of DM, lower hemoglobin level, lower serum albumin level, higher dialysate/plasma creatinine ratio, and the occurrence of infective episodes and cardiovascular events during follow-up were independent predictors of technique failure. The present study shows the importance of HS-CRP in the prediction of 2-year mortality and technique survival in PD patients independent of age, diabetes, hypoalbuminemia, and the occurrence of cardiovascular events.