C-reactive protein as a cardiovascular risk factor and its therapeutic implications in end-stage renal disease patients.

Abstract

We observed the association between a persistent elevation of C-reactive protein (CRP) level and the presence of ischemic heart disease in 73 peritoneal dialysis (PD) patients. Twenty-six patients showed an elevation of CRP for more than 6 months. Seventeen (65%) of the 26 patients had positive thallium single photon computed tomography (SPECT). Three of 9 patients who had a persistent elevation of CRP and negative thallium SPECT had a history of cerebral infarction or peripheral vascular disease. Therefore, 77% (20/26) of an elevated CRP level that lasted longer than 6 months can be explained by the presence of atherosclerotic vascular disease. There are as yet no valid recommendations on how chronic inflammation should be handled. We found that aspirin 200 mg daily for 8 weeks induce no significant changes of the CRP levels in PD patients (0.22 vs. 0.18 mg/dL, p > 0.05). However, 62 HD patients were randomly assigned to treatment group (simvastatin 20 mg/day) and control group. After 8 weeks medication, hs-CRP levels significantly reduced from a median of 0.23 mg/dL to 0.12 mg/dL.