title: Increasing high-sensitive C-reactive protein level predicts peritonitis risk in chronic peritoneal dialysis patients.
abstract: BACKGROUND
  The aim of this study was to evaluate whether a high baseline level of high-sensitivity C-reactive protein (hs-CRP) or changes in the level predicts the risk of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD).
  
  
  METHODS
  A prospective, cross-sectional, case-control study was conducted in a single hospital-based PD unit. A total of 327 patients were included in the study. Serum hs-CRP was measured annually for 2 years. Patients were divided into 4 groups according to the changes in annual hs-CRP levels (at baseline and at 1 year intervals): group 1 (from <5 mg/L to <5 mg/L, n = 171), group 2 (from <5 mg/L to ≥5 mg/L, n = 45), group 3 (from ≥5 mg/L to <5 mg/L, n = 45), and group 4 (from ≥5 mg/L to ≥5 mg/L, n = 80). Demographics, biochemistry results, PD adequacy indices, and peritonitis risk were compared between the groups.
  
  
  RESULTS
  The initial serum albumin level was similar in the 4 groups (p = 0.12). There was a negative linear correlation between the serial albumin change (∆alb) and serial hs-CRP change (∆hs-CRP; r = -0.154, p = 0.005). The hazard ratio (HR) for peritonitis was significantly higher in group 2 (HR = 1, reference) than in group 4 (HR = 0.401, 95% CI 0.209 - 0.769). Group 2 had a greater serum albumin decline rate (∆alb: -3% ± 9%) and hs-CRP elevation rate (∆hs-CRP: 835% ± 1232%) compared to those for the other groups.
  
  
  CONCLUSIONS
  A progressive increase in the hs-CRP level was associated with a corresponding decline in the serum albumin level. Progressive rather than persistently high levels of serum hs-CRP predicted peritonitis risk in CAPD patients.
authors.affiliation: Division of Nephrology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Rd, Kaohsiung, Niao Song District, Taiwan. alfonjch@seed.net.tw.
authors.forename: Yu-Jen
authors.initials: YJ
authors.lastname: Su
authors.forename: Shang-Chih
authors.initials: SC
authors.lastname: Liao
authors.forename: Ben-Chung
authors.initials: BC
authors.lastname: Cheng
authors.forename: Jyh-Chang
authors.initials: JC
authors.lastname: Hwang
authors.forename: Jin-Bor
authors.initials: JB
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D016022:Case-Control Studies; D015984:Causality; D015897:Comorbidity; D003430:Cross-Sectional Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010522:Periostitis / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein