Abstract
An elevated CRP level is associated with increased mortality in dialysis pts but the impact of occasional vs persistent inflammation is not known. Objective: To assess the influence on survival of fluctuating vs persistent inflammation in HD pts. Methods: We prospectively (bimonthly) analysed: CRP, S-Alb and fibrinogen in 180 HD pts (49 ± 14 y, 54 % M, 9% DM) with a mean follow up of 21 months. The nutritional status was evaluated by SGA. According to the median of 4 consecutive measurements of CRP and by using the receiver operating characteristics to determine the criteria for inflammation, the patients were allocated into 3 groups: Group 1(n = 64), non-inflamed (CRP < 4.8 mg/l); Group 2 (n = 67), fluctuating levels of CRP (CRP 4.8–10.3 mg/l); and Group 3 (n = 49), persistently inflamed (CRP > 10.3 mg/l). Cox proportional hazard analysis was used to assess independent predictors of survival, and mortality was analyzed by Kaplan Meier analysis. Results: The median baseline CRP was 3.6 (range 3.2 to 82) mg/l. The mean ± SD concentration of fibrinogen was 42 ± 11, 50 ± 12 and 57 ± 12 g/l (p < 0.001), and of S-Alb, 35 ± 3, 35 ± 3 and 34 ± 4 g/l (p = 0.3) for Groups 1, 2 and 3, respectively. The incidence of malnutrition was 57%, 59% and 72% in Groups 1, 2 and 3, respectively (p = 0.22). The survival rate (Kaplan Meier) was significantly different among the groups (chi-square 11.65; p = 0.003). Whereas the survival in Group 3 was only 70% after 21 months, it was similar in Group 1 (91%) and Group 2 (90%). A single measurement of CRP, and age, S-Alb and malnutrition were independent predictors of mortality (Cox analysis). Conclusion: An occasional elevation of CRP in HD pts appears to be relatively benign and the mortality predictive effect of a single high CRP level is therefore mainly related to its association with a persistent increase in CRP which on the other hand is a strong predictor of outcome.
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