C-reactive protein and low albumin are predictors of morbidity and cardiovascular events in chronic kidney disease (CKD) 3-5 patients

Abstract Background and Aims High-sensitivity C-reactive protein (hs-CRP) level is lower in East Asians than in the Western people and its clinical significance needs to be further explored. We aimed to investigate whether hs-CRP could function as a biomarker in Korean CKD patients. Method We studied the association of hs-CRP with adverse clinical outcomes in 2,018 patients from the KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD). The primary outcome was a composite of extended major cardiovascular events (MACE) or all-cause mortality. Extended MACE (eMACE) included non-fatal cardiovascular events, symptomatic arrhythmia, and cardiac death. The secondary endpoints were separate outcome of eMACE, all-cause death, and adverse kidney outcome. We also evaluated predictive ability of hs-CRP for the primary outcome. Results The median hs-CRP level was 0.60 mg/L (IQR 0.2-1.7), and the mean eGFR was 53.6 ml/min/1.73 m2. During the mean follow-up of 3.9 years, there were 125 (6.2%) eMACEs and 80 (4.0%) deaths. The primary composite outcome occurred more frequently in patients with higher hs-CRP level than in those with lower hs-CRP level. In multivariable Cox analysis after adjustment of confounders, there was a graded association of hs-CRP with the primary outcome. The HRs (95% CI) for hs-CRP of 1.0 to 2.99, and ≥ 3.0 mg/L were 1.37 (0.89-2.12) and 2.20 (1.36-3.56), compared with hs-CRP of <1.0 mg/L. In analyses of secondary outcomes, this association was consistent for eMACE and all-cause death; however, hs-CRP was not associated with adverse kidney outcomes. Finally, prediction models failed to show improvement of predictive performance of hs-CRP compared to conventional factors. Conclusion In Korean CKD patients, serum hs-CRP level was low and significantly associated with higher risk of eMACEs and mortality. However, a low serum hs-CRP level was not predictive of adverse kidney outcome, and the predictive performance of hs-CRP was not strong.

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C-reactive protein as a predictor of cardiovascular events in elderly patients with chronic kidney disease

Journal of Nephrology ◽

10.5301/jn.5000047 ◽

2011 ◽

Vol 25 (5) ◽

pp. 719-725 ◽

Cited By ~ 6

Author(s):

Diana Jalal ◽

Michel Chonchol ◽

Thorleif Etgen ◽

Dirk Sander

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Elderly Patients ◽

Cardiovascular Events ◽

C Reactive Protein ◽

Reactive Protein

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High-sensitivity C-reactive Protein as a Marker of Future Cardiovascular Events in Chronic Kidney Disease Stage-5 Patients

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/44704.13937 ◽

2020 ◽

Author(s):

Nisha Abraham ◽

C Beena ◽

Sangeetha Merrin Varghese

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Roc Curve ◽

Cardiovascular Events ◽

High Sensitivity ◽

C Reactive Protein ◽

Reactive Protein ◽

Ckd Stage ◽

Hs Crp ◽

Esrd Patients

Introduction: Chronic Kidney Disease (CKD) has been recognised as a worldwide health threat and understanding its complex patho-physiological mechanisms could go a long way in taking care of patients with CKD. One of the most important causes for mortality in End Stage Renal Disease (ESRD) patients is Cardiovascular Disease (CVD). ESRD is a low grade chronic inflammatory state, suspected to promote atherosclerosis. Aim: To determine, if there is any association between elevated High-sensitivity C-Reactive Protein (hs-CRP) and development of future cardiovascular events in stage-5 CKD patients. Materials and Methods: Forty-five CKD stage-5 patients were included in the study, after ruling out patients with established CVD. According to categorisation proposed by the American Heart Association for the cut-off value of hs-CRP-value (3 mg/L), patients were divided into two groups. Those who had hs-CRP more than 3 mg/L were considered to have ‘elevated hs-CRP’ and those who had a value 3 mg/L and below were considered to have ‘normal hs-CRP’ levels. These patients were followed-up monthly, for a period of one year to record any occurrence of cardiovascular events (coronary events/cerebrovascular accidents/peripheral occlusive vascular disease). Statistical Package for the Social Sciences (SPSS) 16.0 was used for analysis. Chi-square test and Mann-Whitney U-test were used for statistical comparison between the groups and a p-value of 0.05 or less was considered to be statistically significant. Receiver Operating Characteristic (ROC) curve was also plotted to determine the cut-off value for hs-CRP based on the occurrence of any cardiovascular event. Results: Baseline hs-CRP level was more than 3 mg/L in 42% of patients. Among those who had elevated hs-CRP, 78.9% of patients developed cardiovascular events during the follow-up period. This signifies a strong association between elevated hs-CRP and CVD in ESRD patients. The hs-CRP cut-off point of 3 mg/L was obtained from ROC curve. Conclusion: There was a significant association between elevated hs-CRP and development of cardiovascular events in ESRD patients. Hence, hs-CRP can be used as a marker of future cardiovascular events in CKD stage-5 patients.

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Serum C-Reactive Protein Levels and Death and Cardiovascular Events in Mild to Moderate Chronic Kidney Disease

International Heart Journal ◽

10.1536/ihj.52.180 ◽

2011 ◽

Vol 52 (3) ◽

pp. 180-184 ◽

Cited By ~ 5

Author(s):

Yorihiko Koeda ◽

Motoyuki Nakamura ◽

Fumitaka Tanaka ◽

Toshiyuki Onoda ◽

Kazuyoshi Itai ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Cardiovascular Events ◽

C Reactive Protein ◽

Protein Levels ◽

Reactive Protein ◽

Moderate Chronic Kidney Disease

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IMPACT OF CHRONIC KIDNEY DISEASE ON CARDIOVASCULAR EVENTS IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION WITH EVEROLIMUS-ELUTING STENT: RISK STRATIFICATION WITH C-REACTIVE PROTEIN

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(18)31667-x ◽

2018 ◽

Vol 71 (11) ◽

pp. A1126

Author(s):

Kazuhiro Dan ◽

Makoto Nakahama ◽

Toru Miyoshi ◽

Hiroshi Ito

Keyword(s):

Chronic Kidney Disease ◽

Percutaneous Coronary Intervention ◽

Kidney Disease ◽

Risk Stratification ◽

Cardiovascular Events ◽

Coronary Intervention ◽

C Reactive Protein ◽

Reactive Protein ◽

Percutaneous Coronary

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Low High‐Sensitivity C‐Reactive Protein Level in Korean Patients With Chronic Kidney Disease and Its Predictive Significance for Cardiovascular Events, Mortality, and Adverse Kidney Outcomes: Results From KNOW‐CKD

Journal of the American Heart Association ◽

10.1161/jaha.120.017980 ◽

2020 ◽

Vol 9 (21) ◽

Author(s):

Changhyun Lee ◽

Keun Hyung Park ◽

Young Su Joo ◽

Ki Heon Nam ◽

Tae‐Ik Chang ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Cardiovascular Events ◽

Primary Outcome ◽

High Sensitivity ◽

Predictive Performance ◽

C Reactive Protein ◽

Korean Patients ◽

Reactive Protein ◽

Hs Crp

Background Inflammation levels are lower in East Asians than in Western people. We studied the association between high‐sensitivity hs‐CRP (C‐reactive protein) and adverse outcomes in Korean patients with chronic kidney disease. Methods and Results We included 2018 participants from the KNOW‐CKD (Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease) between April 2011 and February 2016. The primary outcome was a composite of extended major cardiovascular events (eMACE) or all‐cause mortality. The secondary end points were separate outcomes of eMACE, all‐cause death, and adverse kidney outcome. We also evaluated predictive ability of hs‐CRP for the primary outcome. The median hs‐CRP level was 0.60 mg/L. During the mean follow‐up of 3.9 years, there were 125 (6.2%) eMACEs and 80 (4.0%) deaths. In multivariable Cox analysis after adjustment of confounders, there was a graded association of hs‐CRP with the primary outcome. The hazard ratios for hs‐CRPs of 1.0 to 2.99 and ≥3.0 mg/L were 1.33 (95% CI, 0.87–2.03) and 2.08 (95% CI, 1.30–3.33) compared with the hs‐CRP of <1.0 mg/L. In secondary outcomes, this association was consistent for eMACE and all‐cause death; however, hs‐CRP was not associated with adverse kidney outcomes. Finally, prediction models failed to show improvement of predictive performance of hs‐CRP compared with conventional factors. Conclusions In Korean patients with chronic kidney disease, the hs‐CRP level was low and significantly associated with higher risks of eMACEs and mortality. However, hs‐CRP did not associate with adverse kidney outcome, and the predictive performance of hs‐CRP was not strong. Registration URL: http://www.clinicaltrials.gov ; Unique identifier: NCT01630486.

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