Impact of C-Reactive Protein and Pulse Pressure Evaluated at the Start of Peritoneal Dialysis on Cardiovascular Events in the Course of Treatment with Peritoneal Dialysis
Restricted accessResearch articleFirst published online May, 2010
Impact of C-Reactive Protein and Pulse Pressure Evaluated at the Start of Peritoneal Dialysis on Cardiovascular Events in the Course of Treatment with Peritoneal Dialysis
Despite a reduced number of infectious complications, cardiovascular (CV) mortality remains unchanged in peritoneal dialysis (PD) patients. The aim of this study was to evaluate the effects of high-sensitivity C-reactive protein (hs-CRP) and pulse pressure (PP) at the start of PD on the development of CV events (CVEs) in these patients.
♦ Methods
The study population was comprised of 291 patients that started PD between January 2003 and June 2008 and were treated for more than 6 months. Baseline clinical, biochemical, and echocardiographic data, indices of dialysis adequacy, and peritoneal transport rate were reviewed ret-respectively. The clinical outcome was the occurrence of a CVE.
♦ Results
Mean duration of follow-up was 28 (range 6 – 70) months. A CVE was observed in 33 patients (11.3%). The 1-, 3-, and 5-year cumulative incidences of CVEs were 4.0%, 13.7%, and 27.5%, respectively. Although multiple variables were correlated with the prevalence of a CVE in the univariate analysis, hs-CRP, PP, and comorbidity remained significant after adjustment: hs-CRP: odds ratio (OR) 4.09 (1.53 – 10.95), p = 0.005; PP: OR 2.79 (1.26 – 6.17), p = 0.012. PP and hs-CRP, which were not intercorrelated in our data, combined adversely to increase the incidence of CVEs. The incidence of CVEs increased with the number of risk factors, which included high hs-CRP, high PP, and the presence of comorbidity (no risk factor, 0%; 1 risk factor, 1.5%; 2 risk factors, 30.8%; 3 risk factors, 53.9%).
♦ Conclusions
Our study suggests that measurements of hs-CRP and PP at the start of PD may be helpful in predicting the development of CVEs in the course of treatment with PD.
OreopoulosD.G.A backward look at the first 20 years of CAPD.Perit Dial Int1998; 18: 360–2.
2.
GrassmannA., GiobergeS., MoellerS., BrownG.ESRD patients in 2004: global overview of patient numbers, treatment modalities and associated trends.Nephrol Dial Transplant2005; 20: 2587–93.
3.
McDonaldS.P., MarshallM.R., JohnsonD.W., PolkinghorneK.R.Relationship between dialysis modality and mortality.J Am Soc Nephrol2009; 20: 155–63.
4.
MaiorcaR., CantaluppiA., CancariniG.C., ScalamognaA., BroccoliR., GrazianiG.Prospective controlled trial of a Y-connector and disinfectant to prevent peritonitis in continuous ambulatory peritoneal dialysis.Lancet1983; 2(8351): 642–4.
5.
HanS.H., LeeS.C., AhnS.V., LeeJ.E., ChoiH.Y., KimB.S.Improving outcome of CAPD: twenty-five years’ experience in a single Korean center.Perit Dial Int2007; 27: 432–40.
HanS.H., LeeJ.E., KimD.K., MoonS.J., KimH.W., ChangJ.H.Long-term clinical outcomes of peritoneal dialysis patients: single center experience from Korea.Perit Dial Int2008; 28(Suppl 3): S21–6.
8.
CollinsA.J., ChenS.C., GilbertsonD.T., FoleyR.N.CKD surveillance using administrative data: impact on the health care system.Am J Kidney Dis2009; 53(Suppl 3): S27–36.
WongJ.S., PortF.K., Hulbert-ShearonT.E., CarrollC.E., WolfeR.A., AgodoaL.Y.Survival advantage in Asian American end-stage renal disease patients.Kidney Int1999; 55: 2515–23.
13.
HemmelgarnB.R., ChouS., WiebeN., CulletonB.F., MannsB.J., KlarenbachS.Differences in use of peritoneal dialysis and survival among East Asian, Indo Asian, and white ESRD patients in Canada.Am J Kidney Dis2006; 48: 964–71.
14.
MostellerR.D.Simplified calculation of body-surface area.N Engl J Med1987; 317: 1098.
15.
DaviesS.J., PhillipsL., NaishP.F., RussellG.I.Quantifying comorbidity in peritoneal dialysis patients and its relationship to other predictors of survival.Nephrol Dial Transplant2002; 17: 1085–92.
16.
MandolfoS., ZucchiA., Cavalieri D'OroL., CorradiB., ImbasciatiE.Protein nitrogen appearance in CAPD patients: what is the best formula?Nephrol Dial Transplant1996; 11: 1592–6.
17.
GottdienerJ.S., BednarzJ., DevereuxR., GardinJ., KleinA., ManningW.J.American Society of Echocardiography recommendations for use of echocardiography in clinical trials.J Am Soc Echocardiogr2004; 17: 1086–119.
18.
DevereuxR.B., AlonsoD.R., LutasE.M., GottliebG.J., CampoE., SachsI.Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings.Am J Cardiol1986; 57: 450–8.
19.
WangA.Y., WangM., WooJ., LamC.W., LuiS.F., LiP.K.Inflammation, residual kidney function, and cardiac hypertrophy are interrelated and combine adversely to enhance mortality and cardiovascular death risk of peritoneal dialysis patients.J Am Soc Nephrol2004; 15: 2186–94.
20.
de SimoneG., DevereuxR.B., DanielsS.R., KorenM.J., MeyerR.A., LaraghJ.H.Effect of growth on variability of left ventricular mass: assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk.J Am Coll Cardiol1995; 25: 1056–62.
21.
Sabatine MS, Morrow DA, Jablonski KA, Rice MM, Warnica JW, Domanski MJ, et al.; PEACE Investigators.Prognostic significance of the Centers for Disease Control/American Heart Association high-sensitivity C-reactive protein cut points for cardiovascular and other outcomes in patients with stable coronary artery disease.Circulation2007; 115: 1528–36.
22.
KimS.B., MinW.K., LeeS.K., ParkJ.S., HongC.D., YangW.S.Persistent elevation of C-reactive protein and ischemic heart disease in patients with continuous ambulatory peritoneal dialysis.Am J Kidney Dis2002; 39: 342–6.
23.
RidkerP.M., CushmanM., StampferM.J., TracyR.P., HennekensC.H.Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men.N Engl J Med1997; 336: 973–9.
24.
CovicA., GoldsmithD.J., FloreaL., Gusbeth-TatomirP., CovicM.The influence of dialytic modality on arterial stiffness, pulse wave reflections, and vasomotor function.Perit Dial Int2004; 24: 365–72.
25.
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: 1501–7.
26.
ChaeC.U., LeeR.T., RifaiN., RidkerP.M.Blood pressure and inflammation in apparently healthy men.Hypertension2001; 38: 399–403.
27.
HerzigK.A., PurdieD.M., ChangW., BrownA.M., HawleyC.M., CampbellS.B.Is C-reactive protein a useful predictor of outcome in peritoneal dialysis patients?J Am Soc Nephrol2001; 12: 814–21.
28.
BenetosA., SafarM., RudnichiA., SmulyanH., RichardJ.L., DucimetieereP.Pulse pressure: a predictor of long-term cardiovascular mortality in a French male population.Hypertension1997; 30: 1410–15.
29.
FranklinS.S., KhanS.A., WongN.D., LarsonM.G., LevyD.Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham Heart Study.Circulation1999; 100: 354–60.
30.
LiuJ.H., ChenC.C., WangS.M., ChouC.Y., LiuY.L., KuoH.L.Association between pulse pressure and 30-month all-cause mortality in peritoneal dialysis patients.Am J Hypertens2008; 21: 1318–23. doi: 10.1038/ajh.2008.286
31.
KhattarR.S., AcharyaD.U., KinseyC., SeniorR., LahiriA.Longitudinal association of ambulatory pulse pressure with left ventricular mass and vascular hypertrophy in essential hypertension.J Hypertens1997; 15: 737–43.
32.
AbramsonJ.L., WeintraubW.S., VaccarinoV.Association between pulse pressure and C-reactive protein among apparently healthy US adults.Hypertension2002; 39: 197–202.
33.
HirschfieldG.M., PepysM.B.C-reactive protein and cardiovascular disease: new insights from an old molecule.QJM2003; 96: 793–807.
34.
Van BortelL.M., Struijker-BoudierH.A., SafarM.E.Pulse pressure, arterial stiffness, and drug treatment of hypertension.Hypertension2001; 38: 914–21.
35.
RidkerP.M., DanielsonE., FonsecaF.A., GenestJ., GottoAMJr., KasteleinJ.J.Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein.N Engl J Med2008; 359: 2195–207.
36.
KarpanouE.A., VyssoulisG.P., StefanadisC.I., CokkinosD.V.Differential pulse pressure response to various antihypertensive drug families.J Hum Hypertens2006; 20: 765–71.
37.
KhanI.H., CampbellM.K., CantarovichD., CattoG.R., DelcroixC., EdwardN.Comparing outcomes in renal replacement therapy: how should we correct for case mix?Am J Kidney Dis1998; 31: 473–8.
38.
BeddhuS., ZeidelM.L., SaulM., SeddonP., SamoreM.H., StoddardG.J.The effects of comorbid conditions on the outcomes of patients undergoing peritoneal dialysis.Am J Med2002; 112: 696–701.
39.
FriedL., BernardiniJ., PirainoB.Comparison of the Charlson Comorbidity Index and the Davies score as a predictor of outcomes in PD patients.Perit Dial Int2003; 23: 568–73.
40.
ToprakA., ReddyJ., ChenW., SrinivasanS., BerensonG.Relation of pulse pressure and arterial stiffness to concentric left ventricular hypertrophy in young men (from the Bogalusa Heart Study).Am J Cardiol2009; 103: 978–84.
41.
HanD.S., HwangJ.H., KangD.H., SongH.Y., NohH., ShinS.K.Current status of peritoneal dialysis in Korea: efforts to achieve optimal outcome.Perit Dial Int1999; 19(Suppl 3): S17–25.
