BACKGROUND: An elevated serum C-reactive protein (CRP) has been shown to be strongly predictive of morbidity and mortality in dialysis patients. However, the significance of high CRP levels in the pre-dialysis period has not been studied extensively. The aim of our study was to analyse the evolution of our pre-dialysis population according to their basal levels of CRP. METHODS: A cohort of 66 pre-dialysis patients was followed for 1 year, after initial determination of serum CRP. The evolution of blood pressure (BP) control, CRP levels, nutritional data (body mass index, serum albumin, prealbumin, transferrin, cholesterol), proteinuria, calcium-phosphorus product, bicarbonate, haemoglobin (Hb), the weekly dose of erythropoietin (Epo)/kg body weight, and the Hb/Epo dose ratio were measured and compared between patients with high (>6 mg/l) or low (<6 mg/l) CRP levels at baseline. The decline in renal function, hospitalization, and death also were measured and compared between the two groups. RESULTS: At baseline, 23 patients (35%) showed high (>6 mg/l) CRP levels. CRP was higher in patients with a previous history of cardiovascular disease (P<0.01), as well as in patients in whom ischaemic nephropathy or nephrosclerosis was the cause of end-stage renal disease (P<0.01). There were no differences between diabetic and non-diabetic patients. During the study period, patients with higher CRP levels at baseline maintained higher levels (P<0.001). During this period, these patients showed lower (P<0.05) albumin concentration, higher bicarbonate levels, lower Hb concentration, and lower Hb/Epo ratio and needed higher Epo doses. There were no differences in systolic BP, the degree of proteinuria, and the decline in renal function between groups; diastolic BP was lower in patients with high CRP levels. Hospitalization was higher (P<0.005) in this group. Only one patient died. CONCLUSIONS: The prevalence of inflammation is high in pre-dialysis patients. High serum CRP levels predict a constant inflammatory state on follow-up. As occurs in dialysis patients, pre-dialysis inflammation predicts lower serum albumin concentration, poorer response to Epo, and a higher hospitalization rate. The decline in renal function does not seem to be related to the inflammatory state. Mortality was not affected on short-term follow-up.
BACKGROUND: An elevated serum C-reactive protein (CRP) has been shown to be strongly predictive of morbidity and mortality in dialysis patients. However, the significance of high CRP levels in the pre-dialysis period has not been studied extensively. The aim of our study was to analyse the evolution of our pre-dialysis population according to their basal levels of CRP. METHODS: A cohort of 66 pre-dialysis patients was followed for 1 year, after initial determination of serum CRP. The evolution of blood pressure (BP) control, CRP levels, nutritional data (body mass index, serum albumin, prealbumin, transferrin, cholesterol), proteinuria, calcium-phosphorus product, bicarbonate, haemoglobin (Hb), the weekly dose of erythropoietin (Epo)/kg body weight, and the Hb/Epo dose ratio were measured and compared between patients with high (>6 mg/l) or low (<6 mg/l) CRP levels at baseline. The decline in renal function, hospitalization, and death also were measured and compared between the two groups. RESULTS: At baseline, 23 patients (35%) showed high (>6 mg/l) CRP levels. CRP was higher in patients with a previous history of cardiovascular disease (P<0.01), as well as in patients in whom ischaemic nephropathy or nephrosclerosis was the cause of end-stage renal disease (P<0.01). There were no differences between diabetic and non-diabeticpatients. During the study period, patients with higher CRP levels at baseline maintained higher levels (P<0.001). During this period, these patients showed lower (P<0.05) albumin concentration, higher bicarbonate levels, lower Hb concentration, and lower Hb/Epo ratio and needed higher Epo doses. There were no differences in systolic BP, the degree of proteinuria, and the decline in renal function between groups; diastolic BP was lower in patients with high CRP levels. Hospitalization was higher (P<0.005) in this group. Only one patient died. CONCLUSIONS: The prevalence of inflammation is high in pre-dialysis patients. High serum CRP levels predict a constant inflammatory state on follow-up. As occurs in dialysis patients, pre-dialysis inflammation predicts lower serum albumin concentration, poorer response to Epo, and a higher hospitalization rate. The decline in renal function does not seem to be related to the inflammatory state. Mortality was not affected on short-term follow-up.
Authors: Finnian R Mc Causland; Brian Claggett; Emmanuel A Burdmann; Kai-Uwe Eckardt; Reshma Kewalramani; Andrew S Levey; John J V McMurray; Patrick Parfrey; Giuseppe Remuzzi; Ajay K Singh; Scott D Solomon; Robert D Toto; Marc A Pfeffer Journal: Am J Kidney Dis Date: 2016-09-16 Impact factor: 8.860
Authors: M J E Dekker; D Marcelli; B Canaud; C J A M Konings; K M Leunissen; N W Levin; P Carioni; V Maheshwari; J G Raimann; F M van der Sande; L A Usvyat; P Kotanko; J P Kooman Journal: Eur J Clin Nutr Date: 2016-04-20 Impact factor: 4.016
Authors: Mohamed E Suliman; Mahmut I Yilmaz; Juan J Carrero; Abdul Rashid Qureshi; Mutlu Saglam; Osman M Ipcioglu; Mujdat Yenicesu; Mengli Tong; Olof Heimbürger; Peter Barany; Anders Alvestrand; Bengt Lindholm; Peter Stenvinkel Journal: Clin J Am Soc Nephrol Date: 2008-04-16 Impact factor: 8.237