Malnutrition and inflammation in peritoneal dialysis patients.
BACKGROUND
Malnutrition, cardiovascular disease, and heightened inflammation are highly prevalent in dialysis patients, and major contributors to morbidity and mortality. We have investigated the inter-relationship between malnutrition and inflammation, and their impact on morbidity and mortality in peritoneal dialysis (PD) patients.


METHODS
We enrolled 63 PD patients beginning in November 2000, and measured C-reactive protein (CRP) and various nutritional markers, including prealbumin.


RESULTS
CRP level was elevated in 29% of the PD patients. Diabetics had higher CRP than non-diabetics (24 vs. 9.3 mg/L, P = 0.016). Patients who were hospitalized during the study had higher enrollment CRP (16 vs. 12.5 mg/L, P = 0.05) and lower enrollment albumin (3.5 vs. 3.9 g/dL, P = 0.002), blood urea nitrogen (BUN) (40 vs. 49 mg/dL, P = 0.034), and protein catabolic rate (nPCR) (0.88 vs. 1.0 g/kg/day, P = 0.02) than those who were not hospitalized. Enrollment level of CRP was inversely correlated with nutritional markers prealbumin (r = -0.5, P < 0.0001) and creatinine (r =-0.35, P < 0.01). After adjusting for age, race, gender, diabetes, and CRP level, prealbumin continued to correlate with other nutritional markers. There was a trend toward association of elevated CRP with all-cause mortality in PD patients.


CONCLUSIONS
It is useful to incorporate prealbumin and CRP in the regular assessment of PD patients, whose survival may be improved by better management of malnutrition and inflammation.
Fein
Paul A
PA
Avram Division of Nephrology, Long Island College Hospital, Brooklyn, New York 11201, USA. pafmd@juno.com
Mittman
Neal
N
Gadh
Rajdeep
R
Chattopadhyay
Jyotiprakas
J
Blaustein
Daniel
D
Mushnick
Robert
R
Avram
Morrell M
MM
D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D007249:Inflammation / Q000401:mortality; D007676:Kidney Failure, Chronic / Q000276:immunology* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D010530:Peritoneal Dialysis / Q000401:mortality*; D011228:Prealbumin / Q000378:metabolism; D011502:Protein-Energy Malnutrition / Q000276:immunology* / Q000401:mortality*; D016019:Survival Analysis
D011228:Prealbumin; D002097:C-Reactive Protein