Serum C-reactive protein (CRP) and risk of death in chronic dialysis patients

Background. The prognosis, of chronic dialysis patients is poor, in part du e to the high incidence of cardiovascular disease. Malnutrition, such as hy poalbuminaemia, has been shown to be a predictor of death in this group of patients, while serum C-reactive protein (CRP) is a predictor of myocardial infarction and sudden death. Thus, the aim of the present study was to det ermine of the relationship between CRP and serum albumin concentration, and the value of baseline CRP data in the prediction of death. Methods. In one of the dialysis units in Okinawa, Japan, baseline CRP data was available (n = 163, 95 men and 68 women) in January 1991. These patient s were divided into two groups according to their baseline CRP levels, with group 1 consisting of CRP greater than or equal to 10 mg/l (n = 128) and g roup 2 of CRP greater than or equal to 10 mg/l (n = 135), and then followed up until the end of 1997. Survival curves were calculated using the Kaplan -Meier method. The statistical significance of the relationship between CRP levels and the risk of death was evaluated by multiple logistic analysis w ith covariables such as age, sex, diabetes mellitus, serum albumin, and blo od pressure. Results. The mean (SD) level of serum albumin was 38 (3) g/l in group 1 and 36 (3) g/l in group 2 (P < 0.00001). The 5-year survival rate was signific antly poorer in group 2 (44.4%) than in group 1 (82.5%) (P < 0.0001). Furth ermore, the risk of death was significantly higher in group 2 (relative ris k 3.48 (95% confidence interval 1.76-6.89), P < 0.0003) by multivariate Cox proportional hazard analysis. Conclusions, CRP is a significant predictor of death in chronic dialysis pa tients, independent of serum albumin and other possible confounders. Dialys is patients with high CRP levels should be carefully evaluated and monitore d regardless of serum albumin concentrations in the normal range.