Clinical consequences of intermittent elevation of C-reactive protein levels in hemodialysis patients

Abstract 

An elevated C-reactive protein (CRP) level has been associated with malnutrition, with erythropoietin resistance during hemodialysis (HD) therapy, and with a higher risk of chronic transplant rejection. Meanwhile, the clinical consequences of intermittent elevations of CRP levels observed among a large group of HD patients are unclear. We sought to compare the inflammatory and nutritional parameters as well as the erythropoietin requirements for HD patients with persistent or intermittent CRP elevations versus subjects with CRP levels in the normal range. The 6-month retrospective clinical and laboratory data of 100 HD patients (age 48.4 ± 14.3 years, HD duration 69.3 ± 49.0 months) were divided into three groups on the basis of at least six monthly values of CRP: for persistent (group 1) or intermittent high (at least one level of CRP ≥10 mg/L); (group 2) versus normal CRP levels (group 3). We compared the estimates of fibrinogen, ICAM-1, VCAM-1, albumin, prealbumin, normalized protein catabolic rate (nPCR), interdialytic weight gain (IDWG), and rhuuEpo/kg/Htc. Significant differences, were observed in fibrinogen, albumin, prealbumin, ICAM-1, nPCR, IDWG, and rHUuEpo/kg/wk values. Like group 1, group 2 patients seemed to show inflammation and malnutrition, namely decreased albumin levels, nPCR, and rHUEpo resistance, when compared with group 3. Finally, intermittent elevations of CRP must be considered to reflect a state of chronic inflammatory response associated with malnutrition and erythropoietin resistance similar to that observed among hemodialysis patients with persistently high CRP levels.