Is C-reactive protein a useful predictor of outcome in peritoneal dialysis patients?
An elevated C-reactive protein (CRP) has recently been shown to be strongly predictive of mortality in hemodialysis patients. However, its predictive value in peritoneal dialysis (PD) patients has not been assessed. A cohort of 50 PD patients was followed prospectively for a 3-yr period, after initial determination of CRP. Patients with an elevated CRP (>6 mg/L; n = 29) had significantly reduced plasma prealbumin (0.36 +/- 0.02 versus 0.44 +/- 0.03 g/L; P: < 0.05), decreased total weekly creatinine clearance (C(Cr); 52.5 +/- 2.3 versus 63.1 +/- 3.2 L/1.73 m(2); P: < 0.01), and increased left ventricular thickness (1.24 +/- 0.05 versus 1.08 +/- 0.06 cm; P: < 0.05) at baseline compared with those who had a normal CRP (< or =6 mg/L; n = 21). Baseline CRP (log-transformed) correlated weakly with baseline Kt/V, C(Cr), and pre-albumin. With the use of a multivariate Cox's proportional hazards model to adjust for potential confounding factors, an elevated CRP was predictive of myocardial infarction (adjusted hazard ratio, 4.8; 95% confidence interval [CI], 1.0 to 23; P: = 0.048) and tended to be predictive of fatal myocardial infarction (adjusted hazard ratio, 6.0; 95% CI, 0.8 to 43; P: = 0.07). However, CRP was not significantly associated with all-cause mortality (adjusted hazard ratio, 2.1; 95% CI,0.8 to 5.4; P: = 0.15). In conclusion, CRP elevation occurs in a substantial proportion of PD patients and is independently predictive of future myocardial infarction. Such patients may warrant closer monitoring and attention to modifiable cardiovascular risk factors.
Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia.
Karen Ann
KA
Herzig
Department of Epidemiology and Population Health Unit, Queensland Institute of Medical Research, Brisbane, Australia.
David Michael
DM
Purdie
Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia.
Wendy
W
Chang
Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia.
Allison Margaret
AM
Brown
Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia.
Carmel Mary
CM
Hawley
Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia.
Scott Bryan
SB
Campbell
Department of Pharmacy, Princess Alexandra Hospital, Brisbane, Australia.
Joanna Mary
JM
Sturtevant
Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia.
Nicole Maree
NM
Isbel
Department of Surgery, Princess Alexandra Hospital, Brisbane, Australia.
David Lawrence
DL
Nicol
Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia.
David Wayne
DW
Johnson
D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood; D010530:Peritoneal Dialysis; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D016896:Treatment Outcome
D002097:C-Reactive Protein