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C-Reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients.
Am J Kidney Dis. 2000 Mar; 35(3):469-76.AJ

Abstract

Hypoalbuminemia predicts death in dialysis patients. Although hypoalbuminemia has been attributed to malnutrition, evidence of inflammation (C-reactive protein [CRP] and cytokine levels) has recently been recognized to predict albumin concentration in dialysis patients. We measured CRP and albumin levels in October 1995 in 91 hemodialysis (HD) patients. During a 34-month follow-up period, we determined the incidence and cause of death. Patients were divided into four groups based on serum albumin levels (<3.5 [lowest quartile], 3.5 to 3.8, 3.9 to 4.0, and >4.0 g/dL [highest quartile]). Survival differed among the four groups (P = 0.0063). Patients with albumin levels greater than 4.0 g/dL had the greatest survival. Kaplan-Meier survival estimates of patients from varying CRP quartiles (<2.6, 2.6 to 5.2, 5.3 to 11.5, and >11.5 microg/mL) differed among the four groups (P < 0.0001). The group with the greatest CRP level (>11.5 microg/mL) had the lowest survival. Multivariate analysis using the Cox proportional hazards model showed that only CRP level (chi-square = 21.11; P < 0.0001) and age (chi-square = 5.44; P = 0.020) predicted death. Albumin level (chi-square = 0.16; P = 0.69) was not predictive. Only when CRP was excluded from the model did low serum albumin level (chi-square = 12. 04; P = 0.0004) predict death. CRP level (chi-square = 16.79; P < 0. 0001) and age (chi-square = 6.38; P = 0.012) also superceded albumin level (chi-square = 0.45; P = 0.51) in predicting cardiovascular mortality. Although values for blood urea nitrogen, creatinine, and normalized protein catabolic rate were significantly less among patients who died, these parameters, as well as cholesterol level and diabetes, were not important predictors of death in multivariate analysis. The acute-phase response or the cause of the acute-phase response is largely responsible for the effect of hypoalbuminemia on mortality in HD patients.

Authors+Show Affiliations

Department of Medicine, Division of Nephrology, and the Department of Statistics, University of California Davis, Sacramento 95817, USA. jyyeun@ucdavis.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

10692273

Citation

Yeun, J Y., et al. "C-Reactive Protein Predicts All-cause and Cardiovascular Mortality in Hemodialysis Patients." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 35, no. 3, 2000, pp. 469-76.
Yeun JY, Levine RA, Mantadilok V, et al. C-Reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis. 2000;35(3):469-76.
Yeun, J. Y., Levine, R. A., Mantadilok, V., & Kaysen, G. A. (2000). C-Reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 35(3), 469-76.
Yeun JY, et al. C-Reactive Protein Predicts All-cause and Cardiovascular Mortality in Hemodialysis Patients. Am J Kidney Dis. 2000;35(3):469-76. PubMed PMID: 10692273.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - C-Reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients. AU - Yeun,J Y, AU - Levine,R A, AU - Mantadilok,V, AU - Kaysen,G A, PY - 2000/2/29/pubmed PY - 2000/3/18/medline PY - 2000/2/29/entrez SP - 469 EP - 76 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 35 IS - 3 N2 - Hypoalbuminemia predicts death in dialysis patients. Although hypoalbuminemia has been attributed to malnutrition, evidence of inflammation (C-reactive protein [CRP] and cytokine levels) has recently been recognized to predict albumin concentration in dialysis patients. We measured CRP and albumin levels in October 1995 in 91 hemodialysis (HD) patients. During a 34-month follow-up period, we determined the incidence and cause of death. Patients were divided into four groups based on serum albumin levels (<3.5 [lowest quartile], 3.5 to 3.8, 3.9 to 4.0, and >4.0 g/dL [highest quartile]). Survival differed among the four groups (P = 0.0063). Patients with albumin levels greater than 4.0 g/dL had the greatest survival. Kaplan-Meier survival estimates of patients from varying CRP quartiles (<2.6, 2.6 to 5.2, 5.3 to 11.5, and >11.5 microg/mL) differed among the four groups (P < 0.0001). The group with the greatest CRP level (>11.5 microg/mL) had the lowest survival. Multivariate analysis using the Cox proportional hazards model showed that only CRP level (chi-square = 21.11; P < 0.0001) and age (chi-square = 5.44; P = 0.020) predicted death. Albumin level (chi-square = 0.16; P = 0.69) was not predictive. Only when CRP was excluded from the model did low serum albumin level (chi-square = 12. 04; P = 0.0004) predict death. CRP level (chi-square = 16.79; P < 0. 0001) and age (chi-square = 6.38; P = 0.012) also superceded albumin level (chi-square = 0.45; P = 0.51) in predicting cardiovascular mortality. Although values for blood urea nitrogen, creatinine, and normalized protein catabolic rate were significantly less among patients who died, these parameters, as well as cholesterol level and diabetes, were not important predictors of death in multivariate analysis. The acute-phase response or the cause of the acute-phase response is largely responsible for the effect of hypoalbuminemia on mortality in HD patients. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/10692273/C_Reactive_protein_predicts_all_cause_and_cardiovascular_mortality_in_hemodialysis_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(00)70200-9 DB - PRIME DP - Unbound Medicine ER -