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NDT Advance Access published online on February 19, 2004
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh052
© 2004 by European Renal Association - European Dialysis and Transplant Association
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Received August 2, 2003
Accepted November 26, 2003

Original Article

Interleukin-6 is a stronger predictor of total and cardiovascular mortality than C-reactive protein in haemodialysis patients

Vincenzo Panichi 1, Umberto Maggiore 2, Daniele Taccola 1, Massimiliano Migliori 1, Giovanni Manca Rizza 1, Cristina Consani 3, Alessio Bertini 1, Stefano Sposini 4, Rafael Perez-Garcia 5, Paolo Rindi 6, Roberto Palla 4, Ciro Tetta 7*

1 Department of Internal Medicine, University of Pisa, Pisa, Italy
2 Nephrology, University of Parma, Parma, Italy
3 Department of Internal Medicine, University of Pisa, Pisa. Italy
4 Division of Nephrology, Regional Hospital, Massa, Italy
5 Servicio de Nefrologia, G. Maranon Hospital, Madrid, Spain
6 Nephrology Division, Regional Hospital, Pisa, Italy
7 Research Extracorporeal Therapy Department, Fresenius Medical Care, Bad Homburg, Germany

* To whom correspondence should be addressed. E-mail: ciro.tetta{at}fmc-ag.com.



  Abstract

Background. Despite the well known association between interleukin-6 (IL-6) and cardiovascular mortality, no study has so far verified whether IL-6 adds prognostic information to that provided by C-reactive protein (CRP).

Methods. A cohort of 218 haemodialysis patients from four different dialytic centres was followed-up retrospectively. Plasma IL-6 and CRP concentrations were determined. Full information on co-morbidities was available in 162 patients.

Results. With respect to the lowest quartile (<3.6 pg/ml for IL-6, and <2.2 mg/l for CRP), the crude relative risk (RR) of death from all causes of the upper quartile (>13.9 pg/ml for IL-6, and >12.8 mg/l for CRP) was 5.20 (95% confidence interval 2.06-13.011) for IL-6 and 3.16 (1.41-7.12) for CRP. When both variables were included, the estimates were 4.10 (1.30-12.96) for IL-6 and 1.29 (0.47-3.57) for CRP. As to continuous variables, the relationship between both variables and mortality tended to level off for the highest values, but became fairly linear after log transformation of the variables. For one unit SD of the log (variable), the RR was 2.09 (1.52-2.88) for IL-6 and 1.66 (1.23-2.24) for CRP. When they were included in the same model, the estimates were 1.90 (1.18-2.82) for IL-6 and 1.16 (0.81-1.66) for CRP.

Conclusions. IL-6 has a stronger predictive value than CRP for cardiovascular mortality and provides independent prognostic information, while conveying most of that provided by CRP.

Keywords: cardiovascular mortality; C-reactive protein; haemodialysis; interleukin-6; outcome


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