The value of time-averaged serum high-sensitivity C-reactive protein in prediction of mortality and dropout in peritoneal dialysis patients
Authors Liu SH, Chen CY, Li YJ, Wu HH, Lin CY, Chen YC, Chang MY, Hsu HH, Ku CL, Tian YC
Received 28 March 2017
Accepted for publication 14 July 2017
Published 16 August 2017 Volume 2017:13 Pages 1009—1021
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Hoa Le
Peer reviewer comments 4
Editor who approved publication: Professor Deyun Wang
Shou-Hsuan Liu,1–3,* Chao-Yu Chen,1,* Yi-Jung Li,1,2 Hsin-Hsu Wu,1,2 Chan-Yu Lin,1 Yung-Chang Chen,1 Ming-Yang Chang,1 Hsiang-Hao Hsu,1 Cheng-Lung Ku,2,3 Ya-Chung Tian1
1Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital and Department of Medicine, 2Graduate Institute of Clinical Medical Sciences, 3Laboratory of Human Immunology and Infectious Diseases, Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
*These authors contributed equally to this work
Purpose: C-reactive protein (CRP) is a useful biomarker for prediction of long-term outcomes in patients undergoing chronic dialysis. This observational cohort study evaluated whether the time-averaged serum high-sensitivity CRP (HS-CRP) level was a better predictor of clinical outcomes than a single HS-CRP level in patients undergoing peritoneal dialysis (PD).
Patients and methods: We classified 335 patients into three tertiles according to the time-averaged serum HS-CRP level and followed up regularly from January 2010 to December 2014. Clinical outcomes such as cardiovascular events, infection episodes, newly developed malignancy, encapsulating peritoneal sclerosis (EPS), dropout (death plus conversion to hemodialysis), and mortality were assessed.
Results: During a 5-year follow-up, 164 patients (49.0%) ceased PD; this included 52 patient deaths (15.5%), 100 patients (29.9%) who converted to hemodialysis, and 12 patients (3.6%) who received a kidney transplantation. The Kaplan–Meier survival analysis and log-rank test revealed a significantly worse survival accumulation in patients with high time-average HS-CRP levels. A multivariate Cox regression analysis revealed that a higher time-averaged serum HS-CRP level, older age, and the occurrence of cardiovascular events were independent mortality predictors. A higher time-averaged serum HS-CRP level, the occurrence of cardiovascular events, infection episodes, and EPS were important predictors of dropout. The receiver operating characteristic analysis verified that the value of the time-average HS-CRP level in predicting the 5-year mortality and dropout was superior to a single serum baseline HS-CRP level.
Conclusion: This study shows that the time-averaged serum HS-CRP level is a better marker than a single baseline measurement in predicting the 5-year mortality and dropout in PD patients.
Keywords: dropout, encapsulating peritoneal sclerosis, high sensitivity C-reactive protein, malignancy, mortality, peritoneal dialysis