C-reactive protein and uremia.

Since the first report of elevated serum levels of C-reactive protein (CRP) predicting all cause and cardiovascular mortality more than 10 years ago, many other studies have recognized that the uremic milieu is associated with a state of chronic inflammation. The causes for inflammation are multiple and have been well studied in the past 10 years. Nondialysis, uremia related and endogenous factors as well as the dialysis procedure itself may be responsible for the high prevalence of inflammation in dialysis patients. Today, CRP serves to improve overall vascular risk stratification and, in the individual, to detect sources of specific infections. Because multiple factors contribute to the milieu of inflammation, the predictive value of CRP is rather nonspecific in dissecting a cause, with respect to the subcomponents of cardiac, vascular, and even noncardiovascular causes of mortality. So far, no specific pharmacologic treatment, including atorvastatin, has been identified that can substantially reduce CRP and accompanying inflammation.