P1567THE ANNUAL VARIATION OF CRA/ALBUMIN RATIO IS AN ACCURATE PROGNOSTIC FACTOR IN DIALYSIS PATIENTS

Abstract

Abstract Background and Aims Protein energy wasting (PEW) is a distinctive malnutrition status in hemodialysis(HD) patients, and it is closely related to poor prognosis. We previously reported that CRP/Alb ratio is useful marker for assessment of malnutrition status in HD patients. However, the value of CRP/Alb ratio calculated by CRP and serum albumin level is considered to be varied over time, and correlation between the amount of change and the prognosis is uncertain. The purpose of this study is to investigate the effect of the changing in CRP/Alb ratio within a certain period of time on prognosis of dialysis patient. Method 320 patients who were received stable dialysis therapy were enrolled in the study. It was analyzed that the relation between the changing in CRP/Alb ratio within one year and the prognosis. Furthermore, patients were divided by the values of CRP/Alb (>0.35) and ΔCRP/Alb ratio (>0.05) as a threshold (4 groups of 2 × 2), and analyzed for the prognostic value. Results During the observation period (median 71 months), 138 patients were died (43.1%). Baseline CRP/albumin ratio, both of continuous value and cut-off value of 0.34 as median, was identified as an independent predictor for 7-year mortality. The CRP / Alb ratio at one year increased from 0.40 (0.46-1.7) to 0.47 (0.22-1.48) (p = 0.0040). The 7-year survival rate was 44.7% in the group with increased ΔCRP / Alb ratio and 57.0% in the group with non-increased (p = 0.020). The adjusted hazard ratio was 1.45 (95% CI 1.02-2.06, p = 0.037, increase group vs non-increase group). On combined setting of each predictors, mortality risk was clearly stratified, and patients with high and increased CRP/albumin ratio had 2.84-fold (95%CI 1.65-5.03) higher risk of mortality compared to patients with low and no-increased CRP/albumin ratio Conclusion The increasing rate of CRP/Alb ratio were strong predictors of mortality as well as the baseline CRP/Alb ratio levels, and both of them additively improved the predictability for mortality in chronic HD patients.