C-reactive protein and prediction of 1-year mortality in prevalent hemodialysis patients

Measurement of C-reactive protein (CRP) levels remains uncommon in North America, although it is now routine in many countries. Using Dialysis Outcomes and Practice Patterns Study data, our primary aim was to evaluate the value of CRP for predicting mortality when measured along with other common in...

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Veröffentlicht in:Clinical journal of the American Society of Nephrology Jg. 6; H. 10; S. 2452
Hauptverfasser: Bazeley, Jonathan, Bieber, Brian, Li, Yun, Morgenstern, Hal, de Sequera, Patricia, Combe, Christian, Yamamoto, Hiroyasu, Gallagher, Martin, Port, Friedrich K, Robinson, Bruce M
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 01.10.2011
Schlagworte:
Adolescent
Adult
Aged
Australia
Biomarkers - blood
C-Reactive Protein - analysis
Europe
Female
Humans
Inflammation Mediators - blood
Japan
Kidney Diseases - diagnosis
Kidney Diseases - immunology
Kidney Diseases - mortality
Kidney Diseases - therapy
Logistic Models
Male
Middle Aged
New Zealand
Predictive Value of Tests
Proportional Hazards Models
Prospective Studies
Renal Dialysis - mortality
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States
Young Adult
New Zealand
Australia
United States
Europe
Japan
ISSN:1555-905X, 1555-905X
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Zusammenfassung:Measurement of C-reactive protein (CRP) levels remains uncommon in North America, although it is now routine in many countries. Using Dialysis Outcomes and Practice Patterns Study data, our primary aim was to evaluate the value of CRP for predicting mortality when measured along with other common inflammatory biomarkers. We studied 5061 prevalent hemodialysis patients from 2005 to 2008 in 140 facilities routinely measuring CRP in 10 countries. The association of CRP with mortality was evaluated using Cox regression. Prediction of 1-year mortality was assessed in logistic regression models with differing adjustment variables. Median baseline CRP was lower in Japan (1.0 mg/L) than other countries (6.0 mg/L). CRP was positively, monotonically associated with mortality. No threshold below which mortality rate leveled off was identified. In prediction models, CRP performance was comparable with albumin and exceeded ferritin and white blood cell (WBC) count based on measures of model discrimination (c-statistics, net reclassification improvement [NRI]) and global model fit (generalized R(2)). The primary analysis included age, gender, diabetes, catheter use, and the four inflammatory markers (omitting one at a time). Specifying NRI ≥5% as appropriate reclassification of predicted mortality risk, NRI for CRP was 12.8% compared with 10.3% for albumin, 0.8% for ferritin, and <0.1% for WBC. These findings demonstrate the value of measuring CRP in addition to standard inflammatory biomarkers to improve mortality prediction in hemodialysis patients. Future studies are indicated to identify interventions that lower CRP and to identify whether they improve clinical outcomes.
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ISSN:1555-905X
1555-905X
DOI:10.2215/CJN.00710111