title: High-sensitivity C-reactive protein predicts mortality and technique failure in peritoneal dialysis patients.
abstract: BACKGROUND
  An elevated level of serum C-reactive protein (CRP) is widely considered an indicator of an underlying inflammatory disease and a long-term prognostic predictor for dialysis patients. This cross-sectional cohort study was designed to assess the correlation between the level of high-sensitivity CRP (HS-CRP) and the outcome of peritoneal dialysis (PD) patients.
  
  
  METHODS
  A total of 402 patients were stratified into 3 tertiles (lower, middle, upper) according to serum HS-CRP level and and followed up from October 2009 to September 2011. During follow-up, cardiovascular events, infection episodes, technique failure, and mortality rate were recorded.
  
  
  RESULTS
  During the 24-month follow-up, 119 of 402 patients (29.6%) dropped out from PD, including 28 patients (7.0%) who died, 81 patients (20.1%) who switched to hemodialysis, and 10 patients (2.5%) who underwent kidney transplantation. The results of Kaplan-Meier analysis and log-rank test demonstrated a significant difference in the cumulative patient survival rate across the 3 tertiles (the lowest rate in upper tertile). On multivariate Cox regression analysis, only higher HS-CRP level, older age, the presence of diabetes mellitus (DM), lower serum albumin level, and the occurrence of cardiovascular events during follow-up were identified as independent predictors of mortality. Every 1 mg/L increase in HS-CRP level was independently predictive of a 1.4% increase in mortality. Multivariate Cox regression analysis also showed that higher HS-CRP level, the presence of DM, lower hemoglobin level, lower serum albumin level, higher dialysate/plasma creatinine ratio, and the occurrence of infective episodes and cardiovascular events during follow-up were independent predictors of technique failure.
  
  
  CONCLUSIONS
  The present study shows the importance of HS-CRP in the prediction of 2-year mortality and technique survival in PD patients independent of age, diabetes, hypoalbuminemia, and the occurrence of cardiovascular events.
authors.affiliation: Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital and Department of Medicine, Chang Gung University, Tao Yuan, Taiwan.
authors.forename: Shou-Hsuan
authors.initials: SH
authors.lastname: Liu
authors.affiliation: Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital and Department of Medicine, Chang Gung University, Tao Yuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao Yuan, Taiwan.
authors.forename: Yi-Jung
authors.initials: YJ
authors.lastname: Li
authors.affiliation: Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital and Department of Medicine, Chang Gung University, Tao Yuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao Yuan, Taiwan.
authors.forename: Hsin-Hsu
authors.initials: HH
authors.lastname: Wu
authors.affiliation: Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital and Department of Medicine, Chang Gung University, Tao Yuan, Taiwan.
authors.forename: Cheng-Chia
authors.initials: CC
authors.lastname: Lee
authors.affiliation: Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital and Department of Medicine, Chang Gung University, Tao Yuan, Taiwan.
authors.forename: Chan-Yu
authors.initials: CY
authors.lastname: Lin
authors.affiliation: Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital and Department of Medicine, Chang Gung University, Tao Yuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao Yuan, Taiwan.
authors.forename: Cheng-Hao
authors.initials: CH
authors.lastname: Weng
authors.affiliation: Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital and Department of Medicine, Chang Gung University, Tao Yuan, Taiwan.
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital and Department of Medicine, Chang Gung University, Tao Yuan, Taiwan.
authors.forename: Ming-Yang
authors.initials: MY
authors.lastname: Chang
authors.affiliation: Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital and Department of Medicine, Chang Gung University, Tao Yuan, Taiwan.
authors.forename: Hsiang-Hao
authors.initials: HH
authors.lastname: Hsu
authors.affiliation: Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital and Department of Medicine, Chang Gung University, Tao Yuan, Taiwan.
authors.forename: Ji-Tseng
authors.initials: JT
authors.lastname: Fang
authors.affiliation: Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital and Department of Medicine, Chang Gung University, Tao Yuan, Taiwan.
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Hung
authors.affiliation: Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital and Department of Medicine, Chang Gung University, Tao Yuan, Taiwan.
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Yang
authors.affiliation: Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital and Department of Medicine, Chang Gung University, Tao Yuan, Taiwan.
authors.forename: Ya-Chung
authors.initials: YC
authors.lastname: Tian
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000150:complications; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007239:Infections / Q000150:complications; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000401:mortality*; D011379:Prognosis; D012044:Regression Analysis; D017211:Treatment Failure
chemical_list: D002097:C-Reactive Protein