To evaluate the predictive value of a single baseline serum C-reactive protein (sCRP) as a marker of mortality in continuous ambulatory peritoneal dialysis (CAPD) patients.
Design
A review of prospectively collected data in a 2-year follow-up study.
Setting
Tertiary medical center.
Patients
The study included 106 patients who were stable and had been on CAPD for a minimum of 3 months.
Main Outcome Measures
Patient survival rate was the main outcome measure of this study. Other outcome measures were technique survival rate, peritonitis rate, and hospitalized days. Covariables used in the survival analysis were age, sex, the presence of cardiovascular disease or diabetes mellitus, sCRP, serum albumin, hematocrit, cholesterol, HDL-cholesterol, malnutrition by subjective global assessment (SGA), weekly Kt/V urea, and weekly standardized creatinine clearance (SCCr).
Results
The 2-year patient survival rate was significantly lower in the increased sCRP group than in the normal sCRP group (66.7% vs 94.1%, p = 0.001), although there was no significant difference in technique failure, peritonitis rate, and hospitalized days between the two groups. By Cox proportional hazards analysis, independent predictors of mortality were: cardiovascular disease (relative risk, RR = 8.96, p < 0.005); increased sCRP level (RR = 1.19, p < 0.05); and high hematocrit (RR = 1.18, p < 0.05).
← Conclusion
Serum CRP at enrollment is an independent predictor of 2-year patient survival in CAPD patients.
HarnettJ.D., KentG.M., FoleyR.N., ParfreyP.S.Cardiac function and hematocrit level.Am J Kidney Dis1995; 25(Suppl 1): S3–7.
2.
GoldwasserP., MittmanN., AntignaniA., BurrellD., MichelM.A., CollierJ.Predictors of mortality in hemodialysis patients.J Am Soc Nephrol1993; 3(9): 1613–22.
3.
AvramM.M., MittmanN., BonominiL., ChattopadhyayJ., FeinP.Markers for survival in dialysis: A seven year prospective study.Am J Kidney Dis1995; 26(1): 209–19.
4.
MittmanN., AvramM.M., BonominiL., OoK., LichtJ., SreedharaR.Hemodialysis (HD) treatment dose is an independent determinant of seven year survival (Abstract).J Am Soc Nephrol1995; 6: 610.
5.
LowrieE.G., LewN.L.Death risk in hemodialysis patients: The predictive value of commonly measured variables and an evaluation of death rate differences between facilities.Am J Kidney Dis1990; 15(5): 458–82.
6.
OwenW.F.Jr, LewN.L., LiuY., LowrieE.G., LazarusJ.M.The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis.N Engl J Med1993; 329(14): 1001–6.
7.
SreedharaR., AvramM.M., BlancoM., BatishR., AvramM.M., MittmanN.Prealbumin is the best nutritional predictor of survival in hemodialysis and peritoneal dialysis.Am J Kidney Dis1996; 28(6): 937–42.
8.
AvramM.M., BonominiL.V., SreedharaR., MittmanN.Predictive value of nutritional markers (albumin, creatinine, cholesterol, and hematocrit) for patients on dialysis for up to 30 years.Am J Kidney Dis1996; 28(6): 910–17.
9.
BergströmJ., HeimbürgerO., LindholmB., QureshiA.R.Elevated serum C-reactive protein is a strong predictor of increased mortality and low serum albumin in hemodialysis (HD) patients (Abstract).J Am Soc Nephrol1995; 6: 573.
10.
HanD.S., LeeS.W., KangS.W., ChoiK.H., LeeH.Y., ChoE.Y.Factors affecting low values of serum albumin in CAPD patients. In: KhannaR., ed. Advances in perito neal dialysis.Toronto: Peritoneal Dialysis Publications, 1996; 12: 288–92.
11.
KeshaviahP.R., NolphK.D., MooreH.L., ProwantB., EmersonP.F., MeyerM.Lean body mass estimation by creatinine kinetics.J Am Soc Nephrol1994; 4: 1475–85.
12.
AcchiardoS.R., MooreL.W., LatourP.A.Malnutrition as the main factor in morbidity and mortality of dialysis patients.Kidney Int1983; 24(Suppl 16): S199–203.
13.
WinchesterJ.F.The albumin dilemma (Editorial).Am J Kidney Dis1992; 20(1): 76–7.
14.
KoppleJ.D.Effect of nutrition on morbidity and mortality in maintenance dialysis patients.Am J Kidney Dis1994; 24(6): 1002–9.
15.
BergströmJ.Nutrition and mortality in hemodialysis (Editorial).J Am Soc Nephrol1995; 6(5): 1329–41.
BlakeP.G., FlowerdewG., BlakeR.M., OreopoulosD.G.Serum albumin in patients on continuous ambulatory peritoneal dialysis -predictors and correlations with outcomes.J Am Soc Nephrol1993; 3(8): 1501–7.
18.
TeehanB.P., SchleiferC.R., BrownJ.M., SiglerM.H., RaimondoJ.Urea kinetic analysis and clinical outcome on CAPD. A five year longitudinal study. In: KhannaR., NolphK.D., ProwantB.F., TwardowskiZ.J., OreopoulosD.G., eds. Advances in peritoneal dialysis.Toronto: Peritoneal Dialysis Bulletin, 1990; 6: 181–5.
19.
Canada-USA (CANUSA) Peritoneal Dialysis Study Group.Adequacy of dialysis and nutrition in continuous peritoneal dialysis: Association with clinical outcomes.J Am Soc Nephrol1996; 7(2): 198–207.
20.
SpiegelD.M., AndersonM., CampbellU., HallK., KellyG., McClureE.Serum albumin: A marker of morbidity in peritoneal dialysis patients.Am J Kidney Dis1993; 21(1): 26–30.
YeunJ.Y., KaysenG.A.Active phase proteins and peritoneal dialysate albumin loss are the main determinants of serum albumin in peritoneal dialysis patients.Am J Kidney Dis1997; 30(6): 923–7.
23.
HaubitzM., SchulzeM., KochK.M.Increase of C-reactive protein serum values following hemodialysis.Nephrol Dial Transplant1990; 5(7): 500–3.
24.
SethiD., MullerB.R., BrownE.A., MainiR.N., GowerP.E.C-Reactive protein in hemodialysis patients with dialysis arthropathy.Nephrol Dial Transplant1988; 3(3): 269–71.
25.
SchindlerR., LonnemannG., ShaldonS., KochK.M., DinarelloC.A.Transcription, not synthesis, of interleukin-1 and tumor necrosis factor by complement.Kidney Int1990; 37(1): 85–93.
26.
SchindlerR., LinnenweberS., SchulzeM., OppermannM., DinarelloC.A., ShaldonS.Gene expression of interleukin-1β during hemodialysis.Kidney Int1993; 43(3): 712–21.
27.
LonnemannG., BingelM., KochK.M., ShaldonS., DinarelloC.A.Plasma interleukin-1 activity in humans undergoing hemodialysis with regenerated cellulosic membranes.Lymphokine Res1987; 6(2): 63–70.
28.
Haeffner-CavaillonN., CavaillonJ.M., CiancioniC., BacleF., DelonsS., KazatchkineM.D.In vivo induction of interleukin-1 during hemodialysis.Kidney Int1989; 35(5): 1212–18.
29.
LibettaC., De NicolaL., RampinoT., De SimoneW., MemoliB.Inflammatory effects of peritoneal dialysis: Evidence of systemic monocyte activation.Kidney Int1996; 49(2): 506–11
30.
CarozziS., NasiniM.G., SchelottoC., CavigliaP.M., CanepaM., ZaninT.Peritoneal macrophage beta-2 microglobulin production and bacterial peritonitis in CAPD patients.ASAIO Trans1990; 36(3): M369–71.
31.
FierenM.W., Van Den BemdG.J., BontaI.L.Peritoneal macrophages from patients on continuous ambulatory peritoneal dialysis show a differential secretion of prostanoids and interleukin-1 beta.Prostaglandins Leukot Essent Fatty Acids1992; 47(1): 23–8.
32.
KimmelP.L., PhilippsT.M., PhillipsE., BoschJ.P.Effect of renal replacement therapy on cellular cytokine production in patients with renal disease.Kidney Int1990; 38(1): 129–35.
33.
NakahamaH., TanakaY., ShiraiD., MiyazakiM., ImaiN., YokokawaT.Plasma interleukin-6 levels in continuous ambulatory peritoneal dialysis and hemodialysis patients.Nephron1992; 61(2): 132–4.
34.
GoldmanM., VandenabeeleP., MoulartJ., AmraouiZ., AbramowiczD., NortierJ.Intraperitoneal secretion of interleukin-6 during continuous ambulatory peritoneal dialysis.Nephron1990; 56(3): 277–80.
35.
LinC.Y., LinC.C., HuangT.P.Serial changes of interleukin-6 and interleukin-8 levels in drain dialysate of uremic patients with continuous ambulatory peritoneal dialysis during peritonitis.Nephron1993; 63(4): 404–8.
36.
HaubitzM., BrunkhorstR., WrengerE., FroeseP., SchulzeM., KochK.M.Chronic induction of C-reactive protein by hemodialysis, but not by peritoneal dialysis therapy.Perit Dial Int1996; 16(2): 158–62.
37.
QureshiA.R., AnderstamB., DanielssonA., GutierrezA., LindholmB., BergströmJ.Predictors of malnutrition in maintenance hemodialysis (HD) patients (Abstract).J Am Soc Nephrol1995; 6: 586.
38.
HindC.R.K., ThomsonS.P., WinearlsC.G., PepysM.B.Serum C- reactive protein concentration in the management of infection in patients treated by continuous ambulatory peritoneal dialysis.J Clin Pathol1985; 38(4): 459–63.
39.
GrauA.J., BuggleF., BecherH., WerleE., HackeW.The association of leukocyte count, fibrinogen and C-reactive protein with vascular risk factors and ischemic vascular diseases.Thromb Res1996; 82(3): 245–55.
40.
KaysenG.A., RathoreV., ShearerG.C., DepnerT.Mechanisms of hypoalbuminemia in hemodialysis patients.Kidney Int1995; 48(2): 510–16.
41.
QureshiA.R., AlvestrandA., DanielssonA., Divino-FilhoJ.C., GutierrezA., LindholmB.Factors predicting malnutrition in hemodialysis patients: A cross-sectional study.Kidney Int1998; 53(3): 773–82.
42.
StruijkD.G., KredietR.T., KoomenG.C., BoeschotenE.W., AriszL.The effect of serum albumin at the start of continuous ambulatory peritoneal dialysis treatment on patient survival.Perit Dial Int1994; 14(2): 121–6.
43.
DaviesS.J., RussellL., BryanJ., PhillipsL., RussellG.I.Comorbidity, urea kinetics, and appetite in continuous ambulatory peritoneal dialysis patients: Their interrelationship and prediction of survival.Am J Kidney Dis1995; 26(2): 353–61.
44.
BarrettB.J., ParfreyP.S., MorganJ., BarreP., FineA., GoldsteinM.B.Prediction of early death in endstage renal disease patients starting dialysis.Am J Kidney Dis1997; 29(2): 214–22.
45.
MaiorcaR., VoneshE.F., CavalliP., De VecchiA., GiangrandeA., La GrecaG.A multicenter, selection-adjusted comparison of patient and technique survivals on CAPD and hemodialysis.Perit Dial Int1991; 11(2): 118–27.
46.
McMillanD.E.Increased levels of acute-phase serum proteins in diabetes.Metabolism1989; 38(11): 1042–6.
