NDT Advance Access originally published online on January 31, 2006
Nephrology Dialysis Transplantation 2006 21(6):1588-1595; doi:10.1093/ndt/gfk092
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Clinical Nephrology
The effect of single and repeatedly high concentrations of C-reactive protein on cardiovascular and non-cardiovascular mortality in patients starting with dialysis
1 Department of Clinical Epidemiology, Leiden University Medical Centre, 2 Hans Mak Institute, Naarden and 3 Department of Nephrology, Academic Medical Centre, University of Amsterdam, The Netherlands
Correspondence and offprint requests to: F. W. Dekker, Leiden University Medical Centre, Department of Clinical Epidemiology, C9-P, PO Box 9600, 2300 RC Leiden, The Netherlands. Email: f.w.dekker{at}lumc.nl
Background. Single measurements of C-reactive protein (CRP) predict cardiovascular mortality in dialysis patients. However, CRP can be temporarily elevated due to infections. Therefore, we investigated the effect of single and repeatedly high concentrations of CRP on cardiovascular and non-cardiovascular mortality in incident dialysis patients.
Methods. In the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), patients starting with dialysis were enrolled between 1997 and 2002. From 635 patients, plasma CRP concentrations were determined at 3 and 6 months of follow-up. Concentrations >10 mg/l were regarded as ‘high’. Patients were followed until time of death, or censored at the end of follow-up (1 May 2004). Cox regression models were performed to compare mortality between patients with repeatedly low CRP, with varying CRP and with repeatedly high CRP.
Results. At the end of follow-up, 247 patients had died, of which 107 patients died of cardiovascular disease (47.8%). Patients with low CRP3 months and high CRP6 months were at increased cardiovascular [adjusted hazard ratio (HR): 2.59, 95% CI: 1.25–5.37] and non-cardiovascular (adjusted HR: 2.18, 95% CI: 1.11–4.28) mortality risk compared with patients with low CRP on both occasions. Moreover, patients with high CRP on both occasions had a higher cardiovascular (adjusted HR: 1.51, 95% CI: 0.72–3.18) and non-cardiovascular (adjusted HR: 2.25, 95% CI: 0.96–5.28) mortality risk than patients with high CRP3 months and low CRP6 months.
Conclusions. Single and repeatedly high concentrations of CRP (>10 mg/l) are related to both cardiovascular and non-cardiovascular mortality in dialysis patients. A high CRP concentration, therefore, has implications for the treatment of cardiovascular as well as non-cardiovascular disease.
Keywords: cardiovascular mortality; C-reactive protein; dialysis patients; inflammation
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  D. J. de Jager, D. C. Grootendorst, K. J. Jager, P. C. van Dijk, L. M. J. Tomas, D. Ansell, F. Collart, P. Finne, J. G. Heaf, J. De Meester, et al. Cardiovascular and Noncardiovascular Mortality Among Patients Starting Dialysis JAMA, October 28, 2009; 302(16): 1782 - 1789. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. L.H. Muntinghe, M. Verduijn, M. W. Zuurman, D. C. Grootendorst, J. J. Carrero, A. R. Qureshi, K. Luttropp, L. Nordfors, B. Lindholm, V. Brandenburg, et al. CCR5 Deletion Protects Against Inflammation-Associated Mortality in Dialysis Patients J. Am. Soc. Nephrol., July 1, 2009; 20(7): 1641 - 1649. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. D. Bradbury, C. W. Critchlow, M. R. Weir, R. Stewart, M. Krishnan, and R. H. Hakim Impact of elevated C-reactive protein levels on erythropoiesis- stimulating agent (ESA) dose and responsiveness in hemodialysis patients Nephrol. Dial. Transplant., March 1, 2009; 24(3): 919 - 925. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. D. Bradbury, M. D. Danese, M. Gleeson, and C. W. Critchlow Effect of Epoetin Alfa Dose Changes on Hemoglobin and Mortality in Hemodialysis Patients with Hemoglobin Levels Persistently below 11 g/dL Clin. J. Am. Soc. Nephrol., March 1, 2009; 4(3): 630 - 637. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Okuno, E. Ishimura, K. Kohno, Y. Fujino-Katoh, Y. Maeno, T. Yamakawa, M. Inaba, and Y. Nishizawa Serum {beta}2-microglobulin level is a significant predictor of mortality in maintenance haemodialysis patients Nephrol. Dial. Transplant., February 1, 2009; 24(2): 571 - 577. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. de Mutsert, D. C. Grootendorst, J. Axelsson, E. W. Boeschoten, R. T. Krediet, F. W. Dekker, and the NECOSAD Study Group Excess mortality due to interaction between protein-energy wasting, inflammation and cardiovascular disease in chronic dialysis patients Nephrol. Dial. Transplant., September 1, 2008; 23(9): 2957 - 2964. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. C. Grootendorst, D. J. de Jager, V. M. Brandenburg, E. W. Boeschoten, R. T. Krediet, F. W. Dekker, and The NECOSAD Study Group Excellent agreement between C-reactive protein measurement methods in end-stage renal disease patients no additional power for mortality prediction with high-sensitivity CRP Nephrol. Dial. Transplant., November 1, 2007; 22(11): 3277 - 3284. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. D. Bradbury, R. B. Fissell, J. M. Albert, M. S. Anthony, C. W. Critchlow, R. L. Pisoni, F. K. Port, and B. W. Gillespie Predictors of Early Mortality among Incident US Hemodialysis Patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS) Clin. J. Am. Soc. Nephrol., January 1, 2007; 2(1): 89 - 99. [Abstract] [Full Text] [PDF]
|
|