title: Abdominal obesity and smoking are important determinants of C-reactive protein in renal transplant recipients.
abstract: BACKGROUND
  C-reactive protein (CRP) is a predictor of coronary heart disease, total mortality and chronic allograft nephropathy in renal transplant recipients. The determinants of CRP have been investigated in the general population, but not in renal transplant recipients. CRP might reflect metabolic aberrations in association with central obesity and systemic atherosclerosis. However, it may also reflect a low-grade immune-mediated response to the graft. In this study we investigated the factors associated with CRP in a renal transplant population.
  
  
  METHODS
  Between August 2001 and July 2003, renal transplant recipients with a functioning graft for more than 1 year (n = 847) were eligible for investigation at their next visit to the outpatient clinic. A total of 606 patients (55% male, aged 51+/-12 years) participated at a median (interquartile range) time of 6.0 (2.6-11.4) years post-transplant.
  
  
  RESULTS
  Median CRP concentration was 2.0 (0.80-4.8) mg/l and mean 24 h creatinine clearance was 62+/-22 ml/min. CRP was significantly associated with body mass index, waist circumference and waist-to-hip ratio (P-value < 0.0001). None of the transplant characteristics except creatinine clearance was associated with CRP. In multiple regression analysis, waist circumference, log sICAM-1 concentration, gender, creatinine clearance and current smoking were independently associated with CRP.
  
  
  CONCLUSIONS
  In renal transplant recipients waist circumference and smoking are the two most important modifiable independent determinants of CRP. Furthermore, CRP is independently associated with the endothelial function parameter sICAM-1 and, in univariate analyses, associated with multiple cardiovascular risk factors. CRP is not associated with any of the transplant-related factors, except for renal transplant function.
authors.affiliation: Renal Transplant Program, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Rutger M
authors.initials: RM
authors.lastname: van Ree
authors.forename: Aiko P J
authors.initials: AP
authors.lastname: de Vries
authors.forename: Leendert H
authors.initials: LH
authors.lastname: Oterdoom
authors.forename: T Hauw
authors.initials: TH
authors.lastname: The
authors.forename: Ron T
authors.initials: RT
authors.lastname: Gansevoort
authors.forename: Jaap J
authors.initials: JJ
authors.lastname: Homan van der Heide
authors.forename: Willem J
authors.initials: WJ
authors.lastname: van Son
authors.forename: Rutger J
authors.initials: RJ
authors.lastname: Ploeg
authors.forename: Paul E
authors.initials: PE
authors.lastname: de Jong
authors.forename: Reinold O B
authors.initials: RO
authors.lastname: Gans
authors.forename: Stephan J L
authors.initials: SJ
authors.lastname: Bakker
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology*; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000097:blood* / Q000150:complications / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood* / Q000150:complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D007166:Immunosuppressive Agents; D002097:C-Reactive Protein; D003404:Creatinine