NDT Advance Access originally published online on July 10, 2007
Nephrology Dialysis Transplantation 2007 22(11):3277-3284; doi:10.1093/ndt/gfm381
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Excellent agreement between C-reactive protein measurement methods in end-stage renal disease patients—no additional power for mortality prediction with high-sensitivity CRP
1Department of Clinical Epidemiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands, 2Department of Nephrology and Clinical Immunology, University Hospital of the RWTH Aachen, Aachen, Germany, 3Hans Mak Insitute, Naarden, 4Department of Nephrology, Amsterdam Medical Center, Amsterdam, The Netherlands and 5The NECOSAD Study Group consisting of: Apperloo AJ, Bijlsma JA, Boekhout M, Boer WH, van der Boog PJM, Büller HR, van Buren M, de Charro FTh, Doorenbos CJ, van den Dorpel MA, van Es A, Fagel WJ, Feith GW, de Fijter CWH, Frenken LAM, van Geelen JACA, Gerlag PGG, Gorgels JPMC, Grave W, Huisman RM, Jager KJ, Jie K, Koning-Mulder WAH, Koolen MI, Kremer Hovinga TK, Lavrijssen ATJ, Luik AJ, van der Meulen J, Parlevliet KJ, Raasveld MHM, van der Sande FM, Schonck MJM, Schuurmans MMJ, Siegert CEH, Stegeman CA, Stevens P, Thijssen JGP, Valentijn RM, Vastenburg GH, Verburgh CA, Vincent HH and Vos PF
Correspondence and offprint requests to: Diana C. Grootendorst, Leiden University Medical Center, Department of Clinical Epidemiology C9-29, P.O. Box 9600 2300 RC Leiden, The Netherlands. Email: d.c.grootendorst{at}lumc.nl
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Abstract |
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Background. The conventional method for C-reactive protein (CRP) measurement is an immunoturbidimetric assay (imCRP, detection limit 
3 mg/l). However, high-sensitivity CRP (hsCRP, detection limit >0.1 mg/l) has been advocated as preferable biomarker for cardiovascular risk assessment. The aim of this study was to determine agreement between imCRP and hsCRP in end-stage renal disease (ESRD) patients, and to examine whether the association between CRP and mortality is comparable when using imCRP or hsCRP.
Methods. Patients from a prospective follow-up study among incident ESRD patients (NECOSAD) with serum CRP available at 3 months of follow-up were included [n = 840, 60% male, mean (SD) age 59 (15) years]. Agreement between imCRP and hsCRP was determined by intraclass correlation coefficient (ICC) and by Cohen's kappa (
) for CRP dichotomized to the presence (CRP >10 mg/l) or absence of systemic inflammation. The association between CRP and mortality was determined by Cox regression analysis and c-statistic.
Results. ICC between imCRP and hsCRP was 0.78, which improved to 0.86 after correction for systematic differences between measurement methods. Systemic inflammation was present in 28.2% and absent in 67.6% of patients according to both methods (discordant in 4.2%), resulting in good agreement between the two methods ( = 0.90). Patients with systemic inflammation had a significantly increased mortality risk compared with patients without systemic inflammation [HRim,adj = 1.49 (95%CI 1.14–1.93) and HRhs,adj = 1.53 (1.18–2.0)]. Predictive capacity of mortality was similar for both CRP methods [c-statisticadj 0.83 (0.79–0.86)].
Conclusion. The agreement between imCRP and hsCRP in patients with ESRD is very good. Furthermore, the association between CRP and mortality in ESRD patients is similar when using imCRP and hsCRP. These data suggest that there is no need to use a high-sensitivity method for the determination of inflammatory status in ESRD patients.
Keywords: dialysis; end-stage renal disease; inflammation; mortality; reliability; survival analysis
Received for publication: 20.10.06
Accepted in revised form: 22. 5.07
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