지속성 외래 복막투석 환자에서 사망률의 예측인자로서 혈청 C - Reactive Pritein 의 의의

Abstract

An increased serum C-reactive protein(sCRP) has been demonstrated to be independent marker of mortality in hemodialysis patients, but predictive role of sCRP in CAPD patients is not clear. To evaluate the predictive value of the single baseline sCRP as a marker of mortality, we performed a corss-sectional study involving 105 CAPD patients and followed these patients for 2 years ratio was 0.9:1; mean CAPD duration was 43.5 months; 11.4% of patients had diabetes and 9.5% of patients had cardiovascular disease. Patients were divided into two groups based on sCRP level: normal sCRP group(n=92, sCRP≤0.8mg/dl) and increased sCRP group(n=13, sCRP>0.8mg/dl). The mean sCRP levels were 0.15±0.17 mg/dl and 4.25± 5.04mg/dl, respectively(P<0.05). In increased sCRP group, there were more diabetic patients(30.7 vs. 8.6%, P<0.05), and serum albumin level was significantly lower compared to normal sCRP group(3.5±0.6 vs. 3.9±0.5g/dl, P<0.05). Other biochemical, urea kinetic and anthropometric data showed no difference between the two groups . Two-year patient survival rate was significantly lower in increased sCRP group than normal sCRP group(66.7 vs. 94.1%, P=0.001) although there was no significant difference in technique failure, peritonitis rate and hospitalized days between the two groups. By Cox Proportional hazards analysis, independent predictors of mortality were cardiovascular disease (relative risk, RR=8.96, P<0.005), increased sCRP level(RR=1.19, P<0.05) and high hematocrit(RR=1.18, P<0.05). Serum CRP was negatively correlated with serum albumin(r=-0.20, P<0.05) and positively nor related with the presence of diabetes mellitus(r=0.31, P=0.001) by stepwise multiple regression analysis. In conclusion, sCRP at enrollment appears to be an independent predictor of 2-year patient survival in CAPD patients.