Comorbidity and acute clinical events as determinants of C-reactive protein variation in hemodialysis patients: implications for patient survival

Am J Kidney Dis. 2009 Jun;53(6):1024-33. doi: 10.1053/j.ajkd.2009.02.008. Epub 2009 Apr 25.


Background: Patients with chronic kidney disease stage 5 have high comorbidity and are prone to inflammation that may contribute to the high cardiovascular mortality risk.

Study design: Three-month observational cohort study of prevalent hemodialysis patients.

Settings & participants: 228 hemodialysis patients (44% women) were included, median age of 66 years, median time on dialysis therapy of 29 months.

Predictors & outcomes: In part 1, comorbidity and intercurrent illness were predictors and C-reactive protein (CRP) level was the outcome. In part 2, serial CRP values were predictors and survival was the outcome.

Measurements: High-sensitivity CRP was measured weekly and interleukin 6 (IL-6), tumor necrosis factor alpha, and IL-10 were measured monthly. Data for comorbidity were collected from patient records to calculate Davies comorbidity score, and self-reported clinical events were recorded weekly.

Results: Median baseline CRP level was 6.7 mg/L (25th to 75th percentiles, 2.5 to 21 mg/L). Baseline CRP level correlated with time-averaged CRP (Spearman rho = 0.76) and individual median of serial CRP values (rho = 0.78; both P < 0.001). Part 1: comorbidity score was significantly associated with greater CRP and IL-6 levels. Age, sex, comorbidity, and 7 of 12 clinical events had significant effects on CRP level variation. Part 2: during a mean follow-up of 29 months, 38% of patients died. Median and mean serial CRP levels were associated with a greater hazard ratio for death (1.013; 95% confidence interval, 1.004 to 1.022) and 1.012 (95% confidence interval, 1.004 to 1.020) than baseline, maximum, and minimum CRP values during the study. Other significant covariates were age, Davies risk group, dialysis vintage, and albumin level.

Limitations: The study is based on observational data for prevalent dialysis patients.

Conclusions: Comorbidity and clinical events are strongly associated with inflammation in hemodialysis patients. Despite variability over time, inflammation assessed by using CRP level is a strong predictor of mortality. Serial measurements provide additional information compared with a single measurement.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • C-Reactive Protein / metabolism*
  • C-Reactive Protein / physiology
  • Cohort Studies
  • Comorbidity
  • Female
  • Follow-Up Studies
  • Humans
  • Inflammation / blood
  • Inflammation / mortality
  • Inflammation / therapy
  • Inflammation Mediators / blood
  • Inflammation Mediators / physiology*
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Renal Dialysis / adverse effects*
  • Survival Rate* / trends
  • Time Factors
  • Treatment Outcome


  • Biomarkers
  • Inflammation Mediators
  • C-Reactive Protein