Serum C-reactive protein and nutritional parameters in hemodialysis patients

Abstract

Background/Aim. Inflammation is the most important factor in the genesis of vascular complication in the endstage renal disease. The serum C-reactive protein (CRP) level is a sensitive marker of systemic inflammation as well as a predisposing factor for cardiovascular and all cause mortality in patients on hemodialysis. Albumin is the negative acute phase protein and its synthesis declines during the inflammation. The patients undergoing hemodialysis have a high prevalence of protein-energy malnutrition, due to reduced protein synthesis and increased degradation. The low serum albumin levels in these patients originate from the complex setting of conditions with systemic inflammatory response as a major cause, malnutrition and overhydratation. The aim of this study was to determine the prevalence of elevated CRP levels in the dialysis patients and to analyse its correlation with serum albumin levels and other parameters of nutritional status. Methods. The study included 49 patients on maintenance hemodialysis at the Department of Hemodialysis, Clinic of Nephrology, Military Medical Academy, Belgrade, Serbia. In order to analyse the parameters, the blood samples were taken during the arteriovenous fistula (AVF) puncture and before the second weekly dialyse. The following parameters were determined: serum levels of urea and creatinine before and after the dialysis procedure, CRP, hemoglobin, fasting glycemia, total cholesterol, triglycerides, albumins, iron, glycosylated hemoglobin (HbA1c), fasting insulinemia and C-peptide only before the dialysis. Results. Out of 49 patients on maintenance hemodialysis, 37 (75.5%) were males and 12 (24.5%) females with the average age of 56.04 ? 13.93 years. The average duration of the dialysis treatment was 7.37 ? 5 years. The high serum CRP levels (more than 3 mg/L) was found in 65.3% of patients. Singificantly more diabetic patients were observed in the group with the higher CRP levels (n = 12) compared to the group with the normal CRP levels (n = 3) (p ? 0.05). A significant positive correlation was found between the CRP value and urea values after the dialysis procedure. We found negative correlation between the CRP values and serum albumin, HbA1c, total cholesterol and triglyceride levels, with no statistical significance. Conclusion. Our study observed a high rate of inflammation in the dialysis patients presenting as high frequency of the elevated CRP levels in the examined group. Negative correlation between CRP levels and serum albumin as well as with some other parameters of nutritional status, suggests that chronic inflammation may be the missing link that actually connect protein energy malnutrition with high morbiditiy and mortality rate in these patients.