Teruel José L, Marcen Roberto, Ocaña Javier, Fernández-Lucas Milagros, Rivera Maite, Tabernero Guadalupe, Ortuño Joaquín
Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, Spain.
Nephron Clin Pract. 2005;100(4):c140-5. doi: 10.1159/000085443. Epub 2005 Apr 25.
BACKGROUND/AIM: The levels of C-reactive protein (CRP) have been related to hypoalbuminemia and the necessity of erythropoietin in patients on maintenance hemodialysis. However, in several studies, the patients' clinical situation is not taken into account. The aim of the present work was to analyze the relationship between CRP and serum albumin and hemoglobin and the erythropoietin resistance index (ERI) in a population of patients on chronic hemodialysis classified according to their clinical situation.
In a cohort of 53 patients followed for 12 months, we analyzed the CRP level and its association with albumin and hemoglobin levels and the ERI (ratio of total weekly erythropoietin dose in units/weight to hemoglobin concentration in g/dl) at the start of the study and at 6 and 12 months thereafter. The patients were divided into three groups based on the presence of inflammatory/infectious disorders during the 4 weeks prior to CRP determination (group A) or the use of a jugular catheter (group B) or an arteriovenous fistula (group C) as vascular access for hemodialysis.
At baseline, the CRP levels (47.1 mg/l in group A, 30.7 mg/l in group B, and 9.4 mg/l in group C) and the ERI (23.9 in group A, 24.6 in group B, and 10.7 in group C) were higher in groups A and B than in group C (p < 0.001 for both parameters). Serum albumin (3.9 g/dl in group A, 4.1 g/dl in group B, and 4.4 g/dl in group C) and hemoglobin (10.4 g/dl in group A, 11.3 g/dl in group B, and 12 g/dl in group C) were lower in groups A and B than in group C (p < 0.05 for serum albumin and p < 0.01 for hemoglobin). In all patients, the baseline CRP level correlated with the albumin level (r = -0.3853, p < 0.01), with the hemoglobin level (r = -0.2950, p < 0.05), and with the ERI (r = 0.4378, p < 0.01). However, if we only considered the group C patients, there was no correlation between baseline CRP and albumin, hemoglobin, and ERI. Similar results were observed at 6 and 12 months.
The CRP, albumin, and hemoglobin levels and the ERI mostly depend on the existence of ongoing inflammatory/infectious disorders and the use of a catheter as vascular access. In the absence of these clinical conditions, we could not correlate the CRP level with the other parameters. The relationship between CRP, albumin, and anemia may be an epiphenomenon.
背景/目的：C反应蛋白（CRP）水平与维持性血液透析患者的低白蛋白血症及促红细胞生成素的需求有关。然而，在一些研究中，未考虑患者的临床情况。本研究的目的是分析根据临床情况分类的慢性血液透析患者群体中CRP与血清白蛋白、血红蛋白及促红细胞生成素抵抗指数（ERI）之间的关系。
在一组53例随访12个月的患者中，我们分析了研究开始时、之后6个月和12个月时的CRP水平及其与白蛋白、血红蛋白水平以及ERI（每周促红细胞生成素总剂量单位/体重与血红蛋白浓度g/dl之比）的关联。根据CRP测定前4周内是否存在炎症/感染性疾病（A组）、是否使用颈内静脉导管（B组）或动静脉内瘘（C组）作为血液透析的血管通路，将患者分为三组。
基线时，A组（47.1mg/l）和B组（30.7mg/l）的CRP水平及ERI（A组为23.9，B组为24.6，C组为10.7）高于C组（两个参数p均<0.001）。A组（3.9g/dl）和B组（4.1g/dl）的血清白蛋白及A组（10.4g/dl）和B组（11.3g/dl）的血红蛋白低于C组（血清白蛋白p<0.05，血红蛋白p<0.01）。在所有患者中，基线CRP水平与白蛋白水平（r=-0.3853，p<0.01）、血红蛋白水平（r=-0.2950，p<0.05）及ERI（r=0.4378，p<0.01）相关。然而，若仅考虑C组患者，基线CRP与白蛋白、血红蛋白及ERI之间无相关性。在6个月和12个月时观察到类似结果。
CRP、白蛋白、血红蛋白水平及ERI主要取决于是否存在持续的炎症/感染性疾病以及是否使用导管作为血管通路。在不存在这些临床情况时，我们无法将CRP水平与其他参数相关联。CRP、白蛋白与贫血之间的关系可能是一种附带现象。
