Serum High Sensitive C-reactive Protein As An Outcome Predictor For Maintenance Hemodialysis Patients

Background and Objective: Recent years, with the improvement of hemodialysis technology, the long-term survival rate of maintenance hemodialysis was significantly elevated. But the complication of hemodialysis was still the key factor which influences the life quality, prognosis and medical burden of patients. The most important factors were cardiovascular disease, malnutrition, and anaemia, especially the mortality rate of atherosclerotic heart disease was increased significantly, which was 10-20-fold-higher than general population. Recent studies showed that inflammation play an important role in the incidence of atherosclerotic and malnutrition in hemodialysis patients. Hemodialysis patients was in a microinflammation state in which the inflammation factors was higher slightly in the normal range, and the patients didn't show any clinical feature, only by checking the C-reactive protein we could find it. A lot of studies suggested that CRP had tight relationship with cardiovascular disease and malnutrition. The sensitivity of routing examination method of CRP was low and couldn't find the change of low level CRP, which was only used in acute inflammation, infection and insult, however the high sensitive CRP (hs-CRP) could find the low level CRP, then evaluated the microinflammation state in maintenance hemodialysis patients earlier and better. Therefore, in this study, in order to evaluate the value of hs-CRP which could predict the prognosis of the maintenance hemodialysis patients, we analyze the relationship between serum hs-CRP of maintenance hemodialysis patients and related factors influencing hemodialysis patients' prognosis.Methody: 1. This study included 65 maintenance hemodialysis patients who were followed-up for more than 3 months in our dialysis center. The serum levels of hs-CRP, hemoglobin(Hgb), albumin(Alb), prealbumin(PAlb), transferin(Tf), triglyceride and cholesterol were determined. The left atrial diameter, interventricular septum thickness and left ventricular posterior wall thickness were measured by echocardiography. These patients were divided into two groups, elevated hs-CRP group(hs-CRP>0.3mg/dl)and normal hs-CRP group(hs-CRP< 0.3mg/dl = . The associations between hs-CRP and nutrition status, the heart structure and atherosis were analyzed respectively.2. 91 maintenance hemodialysis patients were enrolled in this study. Serum hs-CRP, Alb, Hgb, creatinine (SCr), blood urea nitrogen(BUN) were measured in pre-hemodialysis at the beginning of study and every three month. Echocardiography was examined every half year. These patients were divided into two groups according to their baseline hs-CRP levels, elevated hs-CRP group consisting of hs-CRP>0.3mg/dl(n=34) and normal hs-CRP group consisting of hs-CRP <0.3mg/dl(n=57). The cardiovascular events, hospitalized events and mortality were recorded during the period of follow up. Survival curves were calculated using the Kaplan-Meier method. The statistical significance of the relationship among hs-CRP levels, the risk of cardiovascular events and death was evaluated by multiple logistic analysis.Results: 1. Alb, preAlb, Tf and tHcy concentration were significantly lower in elevated hs-CRP group. There were negative relationship between hs-CRP, Alb, preAlb, Tf and tHcy, and positive relationship among hs-CRP, EPO/Hct, left ventricular diameter, interventricular septum thickness, left ventricular posterior wall thickness, intima-medial thickness of carotid artery, presence of atherosclerotic respectively.2. The patients' age in elevated hs-CRP group was significantly higher than those in normal hs-CRP group. Incidence rate of cardiovascular events, hospitalized events and mortality were significantly increased in elevated hs-CRPgroup. Logistic regression analysis showed a significant correlation between serum hs-CRP and the cardiovascular events, hospitalized events and mortality. Kaplan-Meier survival analysis showed a significant difference between elevated hs-CRP and normal hs-CRP group. Furthermore, the risk of death was significantly higher in elevated hs-CRP group by multivariate Cox proportional hazard analysis.Conclusion: 1. Some maintenance hemodialysis patients have elevated serum hs-CRP level;2. Serum hs-CRP level is correlated with age, malnutrition, atherosis, left ventricular hypertrophy and the cardiovascular events;3. Patients with elevated hs-CRP level have higher mortality;4. The function of left venture will be injuried deeply, if the microinflammation state in patients couldn't be corrected in time.