Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
Nephrol Dial Transplant. 2010 Nov;25(11):3717-23. doi: 10.1093/ndt/gfq273. Epub 2010 May 19.
An increase in C-reactive protein (CRP) levels during a single haemodialysis (HD) session has been associated with mortality. These associations, however, are difficult to understand from the current understanding of CRP metabolism.
In 190 Swedish haemodialysis (HD) patients from the Mapping of Inflammatory Markers in Chronic Kidney Disease (MIMICK) cohort, CRP was measured before and after a HD session. During follow-up, events of death and censoring were recorded, and hazard ratios were calculated and analysed as a function of CRP variation. Results were replicated in 94 Dutch HD patients from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD). In this cohort, also correlation and kappa statistics were calculated to assess concordance in CRP changes amid multiple dialysis sessions from the same individuals.
In both cohorts, mean CRP values did not increase during a single HD session. In the MIMICK, median (interquartile range) dialysis vintage was 29.0 (14.8-57.0) months. In both crude [hazard ratio (95% confidence interval): 1.008 (0.971-1.047)] and multivariate Cox models [0.996 (0.949-1.046)], no association was observed with mortality. In the NECOSAD, individuals endured 6.0 (6.0-12.0) months on dialysis. No association was found with mortality neither in a crude [0.961 (0.908-1.018)] nor in an adjusted analysis [0.978 (0.923-1.037)]. Finally, the concordance between changes in different sessions was poor.
CRP changes during a single HD session do not associate with mortality, thereby adding to the biological uncertainty concerning the ability of CRP to rise in such a short period.
单次血液透析（HD）过程中 C 反应蛋白（CRP）水平的升高与死亡率有关。然而，从目前对 CRP 代谢的理解来看，这些关联很难理解。
在来自炎症标志物在慢性肾脏病中的映射（MIMICK）队列的 190 名瑞典血液透析（HD）患者中，在 HD 治疗前后测量 CRP。在随访期间，记录死亡和删失事件，并计算危险比，并作为 CRP 变化的函数进行分析。结果在来自荷兰透析充分性合作研究（NECOSAD）的 94 名荷兰 HD 患者中得到复制。在该队列中，还计算了相关和 Kappa 统计数据，以评估来自同一患者的多次透析过程中 CRP 变化的一致性。
在两个队列中，单次 HD 治疗过程中平均 CRP 值没有增加。在 MIMICK 中，中位数（四分位间距）透析龄为 29.0（14.8-57.0）个月。在未校正和多变量 Cox 模型中，死亡率均无相关性[风险比（95%置信区间）：1.008（0.971-1.047）]。在 NECOSAD 中，个体接受透析治疗的时间为 6.0（6.0-12.0）个月。在未校正分析[0.961（0.908-1.018）]和校正分析[0.978（0.923-1.037）]中，死亡率均无相关性。最后，不同透析阶段变化之间的一致性很差。
单次 HD 治疗过程中 CRP 的变化与死亡率无关，这进一步增加了 CRP 在如此短时间内升高的生物学不确定性。
