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J Am Soc Nephrol 12:814-821, 2001
© 2001 American Society of Nephrology

Is C-Reactive Protein a Useful Predictor of Outcome in Peritoneal Dialysis Patients?

KAREN ANN HERZIG*, DAVID MICHAEL PURDIE{dagger}, WENDY CHANG*, ALLISON MARGARET BROWN*, CARMEL MARY HAWLEY*, SCOTT BRYAN CAMPBELL*, JOANNA MARY STURTEVANT{ddagger}, NICOLE MAREE ISBEL*, DAVID LAWRENCE NICOL§ and DAVID WAYNE JOHNSON*

* Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia.
{ddagger} Department of Pharmacy, Princess Alexandra Hospital, Brisbane, Australia.
§ Department of Surgery, Princess Alexandra Hospital, Brisbane, Australia.
{dagger} Department of Epidemiology and Population Health Unit, Queensland Institute of Medical Research, Brisbane, Australia.

Correspondence to Dr. David W. Johnson, Department of Renal Medicine, Level 2, Ambulatory Renal and Transplant Services Building, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane Q 4102, Australia. Phone: 61-7-3240-5080; Fax: 61-7-3240-5480; E-mail: johnsond{at}health.qld.gov.au

Abstract. An elevated C-reactive protein (CRP) has recently been shown to be strongly predictive of mortality in hemodialysis patients. However, its predictive value in peritoneal dialysis (PD) patients has not been assessed. A cohort of 50 PD patients was followed prospectively for a 3-yr period, after initial determination of CRP. Patients with an elevated CRP (>6 mg/L; n = 29) had significantly reduced plasma prealbumin (0.36 ± 0.02 versus 0.44 ± 0.03 g/L; P < 0.05), decreased total weekly creatinine clearance (CCr; 52.5 ± 2.3 versus 63.1 ± 3.2 L/1.73 m2; P < 0.01), and increased left ventricular thickness (1.24 ± 0.05 versus 1.08 ± 0.06 cm; P < 0.05) at baseline compared with those who had a normal CRP (<=6 mg/L; n = 21). Baseline CRP (log-transformed) correlated weakly with baseline Kt/V, CCr, and pre-albumin. With the use of a multivariate Cox's proportional hazards model to adjust for potential confounding factors, an elevated CRP was predictive of myocardial infarction (adjusted hazard ratio, 4.8; 95% confidence interval [CI], 1.0 to 23; P = 0.048) and tended to be predictive of fatal myocardial infarction (adjusted hazard ratio, 6.0; 95% CI, 0.8 to 43; P = 0.07). However, CRP was not significantly associated with all-cause mortality (adjusted hazard ratio, 2.1; 95% CI,0.8 to 5.4; P = 0.15). In conclusion, CRP elevation occurs in a substantial proportion of PD patients and is independently predictive of future myocardial infarction. Such patients may warrant closer monitoring and attention to modifiable cardiovascular risk factors.




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