Environmental Carbon Monoxide Level Is Associated With the Level of High-Sensitivity C-reactive Protein in Peritoneal Dialysis Patients

Medicine (Baltimore). 2014 Nov;93(26):e181. doi: 10.1097/MD.0000000000000181.


Inflammation is highly prevalent among peritoneal dialysis (PD) patients. High-sensitivity C-reactive protein (hs-CRP) is the most widely used inflammatory marker in clinical medicine and is correlated with mortality in PD patients. Air pollution is associated with systemic inflammation. The aim of this cross-sectional study was to assess the role of air pollutants and other clinical variables on hs-CRP values in PD patients.We recruited a total of 175 patients who had been undergoing continuous ambulatory PD or automated PD for at least 4 months and regularly followed up. Air pollution levels were recorded by a network of 27 monitoring stations near or in the patients' living areas throughout Taiwan. The 12-month average concentrations of particulate matter (PM) with an aerodynamic diameter of <10 and <2.5 μm (PM10 and PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) were included.In stepwise linear regression, after adjustment for related factors, white blood cell count (β: 0.27, 95% confidence interval [CI] [0.71, 2.11]) and CO level (β: 0.17, 95% CI [2.5, 21.32]) were positively associated with hs-CRP and serum albumin levels (β: -0.25, 95% CI [-13.69, -3.96]) and normalized protein nitrogen appearance (β: -0.18, 95% CI [-17.7, -2.51]) was negatively associated with hs-CRP. However, serum indoxyl sulfate and p-cresyl sulfate levels were not significantly associated with hs-CRP (P > 0.05).In PD patients, the environmental CO level was positively correlated with hs-CRP level.

MeSH terms

  • Adult
  • Air Pollutants / analysis*
  • Air Pollution
  • Biomarkers / blood
  • C-Reactive Protein / metabolism*
  • Carbon Monoxide / analysis*
  • Cross-Sectional Studies
  • Environmental Monitoring
  • Female
  • Humans
  • Kidney Failure, Chronic / blood*
  • Kidney Failure, Chronic / pathology
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Peritoneal Dialysis*
  • Prospective Studies
  • Risk Factors
  • Taiwan


  • Air Pollutants
  • Biomarkers
  • Carbon Monoxide
  • C-Reactive Protein