Is C-reactive protein a useful predictor of outcome in peritoneal dialysispatients?

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 initi al determination of CRP. Patients with an elevated CRP (>6 mg/L; n = 29) ha d significantly reduced plasma prealbumin (0.36 +/- 0.02 versus 0.44 +/- 0. 03 gn; P < 0.05), decreased total weekly creatinine clearance (C-Cr; 52.5 /- 2.3 versus 63.1 +/- 3.2 L/1.73 m(2); P < 0.01), and increased left ventr icular thickness (1.24 +/- 0.05 versus 1.08 +/- 0.06 cm; P < 0.05) at basel ine compared with those who had a normal CRP (<less than or equal to>6 mg/L ; n = 21). Baseline CRP (log-transformed) correlated weakly with baseline K t/V, C-Cr, and pre-albumin. With the use of a multivariate Cox's proportion al hazards model to adjust for potential confounding factors, an elevated C RP 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 predictiv e of fatal myocardial infarction (adjusted hazard ratio, 6.0; 95% CI, 0.8 t o 43; P = 0.07), However, CRP was not significantly associated with all-cau se 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 pati ents may warrant closer monitoring and attention to modifiable cardiovascul ar risk factors.