C-reactive protein and body mass index independently predict mortality in kidney transplant recipients.
C-reactive protein (CRP) is a risk factor for cardiovascular outcomes and mortality in the general population. To date, there are no prospective studies of the association between CRP and mortality or allograft loss in kidney transplant recipients (KTR). In 1995, 438 consecutive KTR were enrolled in this prospective study. Important information on demographic, clinical and immunological characteristics was collected at baseline, and CRP was measured using standard methods. Patients were then followed-up for a median 7.8 years. Time-to-event analyses (univariate and multivariate Cox proportional hazards regression models) were used to study the main outcomes: all-cause mortality and kidney allograft loss, defined as the earlier of return to dialysis, re-transplantation, or death. From univariate analyses, we found that CRP >or=0.5 mg/dL was associated with a 83% greater mortality risk compared with lower levels of this inflammatory marker [hazard ratio (HR) = 1.83; 95% confidence interval (CI): 1.23-2.72; p = 0.003]. After multivariate adjustment, patients with a CRP >or=0.5 mg/dL had a 53% higher mortality risk compared with patients whose CRP was below that threshold (HR = 1.53; 95% CI: 1.01-2.31; p = 0.04). No associations between CRP and the risk of kidney allograft loss were detected. Furthermore, we were not able to detect any effect modification between CRP and body mass index on the outcomes under study. We conclude that CRP predicts all-cause mortality, but not allograft loss in stable KTR.
Winkelmayer
Wolfgang C
WC
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. wolfgang@post.harvard.edu
Lorenz
Matthias
M
Kramar
Reinhard
R
Födinger
Manuela
M
Hörl
Walter H
WH
Sunder-Plassmann
Gere
G
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007249:Inflammation; D007674:Kidney Diseases / Q000401:mortality; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome
D002097:C-Reactive Protein