Snaedal Sunna, Heimbürger Olof, Qureshi Abdul Rashid, Danielsson Anders, Wikström Björn, Fellström Bengt, Fehrman-Ekholm Ingela, Carrero Juan Jesús, Alvestrand Anders, Stenvinkel Peter, Bárány Peter
Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Am J Kidney Dis. 2009 Jun;53(6):1024-33. doi: 10.1053/j.ajkd.2009.02.008. Epub 2009 Apr 25.
Patients with chronic kidney disease stage 5 have high comorbidity and are prone to inflammation that may contribute to the high cardiovascular mortality risk.
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.
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.
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.
The study is based on observational data for prevalent dialysis patients.
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.
慢性肾脏病5期患者合并症多，且易于发生炎症，这可能是心血管疾病死亡风险高的原因。
对接受血液透析的现患患者进行为期3个月的观察性队列研究。
纳入228例血液透析患者（44%为女性），中位年龄66岁，透析治疗中位时间29个月。
在第1部分中，合并症和并发疾病为预测因素，C反应蛋白（CRP）水平为结局。在第2部分中，系列CRP值为预测因素，生存率为结局。
每周测量高敏CRP，每月测量白细胞介素6（IL-6）、肿瘤坏死因子α和IL-10。从患者记录中收集合并症数据以计算戴维斯合并症评分，并每周记录自我报告的临床事件。
基线CRP水平中位数为6.7 mg/L（第25至75百分位数为2.5至21 mg/L）。基线CRP水平与时间平均CRP相关（Spearman相关系数ρ = 0.76），与系列CRP值的个体中位数相关（ρ = 0.78；均P < 0.001）。第1部分：合并症评分与更高的CRP和IL-6水平显著相关。年龄、性别、合并症以及12项临床事件中的7项对CRP水平变化有显著影响。第2部分：在平均29个月的随访期间，38%的患者死亡。系列CRP水平中位数和均值与死亡风险比更高相关（1.013；95%置信区间为1.004至1.022），与研究期间的基线、最高和最低CRP值相比，风险比为1.012（95%置信区间为1.004至1.020）。其他显著的协变量为年龄、戴维斯风险组、透析龄和白蛋白水平。
本研究基于现患透析患者的观察性数据。
合并症和临床事件与血液透析患者的炎症密切相关。尽管随时间存在变异性，但通过CRP水平评估的炎症是死亡率的强预测因素。与单次测量相比，系列测量可提供更多信息。
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