PLoS ONE (Jan 2014)

High-sensitivity C-reactive protein predicts mortality and technique failure in peritoneal dialysis patients.

  • Shou-Hsuan Liu,
  • Yi-Jung Li,
  • Hsin-Hsu Wu,
  • Cheng-Chia Lee,
  • Chan-Yu Lin,
  • Cheng-Hao Weng,
  • Yung-Chang Chen,
  • Ming-Yang Chang,
  • Hsiang-Hao Hsu,
  • Ji-Tseng Fang,
  • Cheng-Chieh Hung,
  • Chih-Wei Yang,
  • Ya-Chung Tian

DOI
https://doi.org/10.1371/journal.pone.0093063
Journal volume & issue
Vol. 9, no. 3
p. e93063

Abstract

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INTRODUCTION: 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.