C - reactive protein predictive marker value and its significance in management of pre dialysis chronic kidney disease patients when correlated with total serum proteins and serum albumin levels: experience in a teaching institution

Authors

  • Balvinder Singh Arora Department of Microbiology, V.M.M.C. and Safdarjung Hospital, New Delhi, India
  • Indu Biswal Department of Microbiology, V.M.M.C. and Safdarjung Hospital, New Delhi, India
  • Poornima Sen Department of Microbiology, V.M.M.C. and Safdarjung Hospital, New Delhi, India
  • Santhosh Rajan Department of Microbiology, V.M.M.C. and Safdarjung Hospital, New Delhi, India
  • Amjad Ali Department of Microbiology, V.M.M.C. and Safdarjung Hospital, New Delhi, India
  • Prabal Rajwanshi Department of Microbiology, V.M.M.C. and Safdarjung Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20170102

Keywords:

Chronic kidney disease, hsCRP

Abstract

Background: Chronic kidney disease (CKD) is imposing newer challenges, not only globally, but, also in India, especially managing the end stage renal disease (ESRD). Screening for CKD at an early stage, by, high sensitivity C reactive protein (hsCRP) with or without other clinical, biochemical or anthropometric parameters helps initiate specific therapy to reduce the progression of renal disease. Although, malnutrition, inflammation and cardio vascular diseases (CVD) have been shown as significant independent risk factors of mortality in CKD patients, but, whether there exists any relationship between hsCRP and serum proteins and serum albumin levels, one of the important indicators of PEM, has not been extensively studied in pre-dialysis CKD patients.

Methods: The study included a total of 60 adult subjects. Of these, 30 were study cases who fulfilled the case definition of CKD and were compared with 30 patients who did not show any signs or symptoms of CKD. As per the objective - hsCRP values were estimated by ELISA test, quantified and statistically correlated with total serum proteins and albumin levels.

Results: A significant difference was found in the mean value of hsCRP in cases and in controls (p value 0.001). No significant difference was observed in the mean level of total serum protein in cases and controls, but, the mean differences in the level of serum albumin between cases and controls was significant. The association of serum albumin and hsCRP was found to be significant (p value <0.001). If a level of serum albumin < 3.5 is taken as a marker of malnutrition, it is found that 66.66% of patients have hypo-albuminaemia.

Conclusions: The present study comes to an important conclusion that hsCRP is a useful  independent predictor of CKD and if correlated with serum albumin levels, it would help clinician manage the patient effectively by initiating an aggressive yet very appropriate therapy at the pre-dialysis stage with the likelihood of an ‘evidence based’ reduction in morbidity and mortality.

References

Nugent RA, Fathima SF, Feigl AB, Chyung D. The burden of chronic kidney disease on developing nations: a 21st century challenge in global health. Nephron Clin Pract. 2001;118:269-77.

Abraham G, Sundaram V, Sundaram V, Matthew M, Leslie N, Sathiah V. C- reactive protein, a valuable predictive marker in chronic kidney disease. Saudi J Kidney Dis Transpl. 2009;20:811-5.

Tsai Y, Lee C, Huang T, Cheng B. Inflammatory marker but not adipokine predicts mortality long term haemodialysis patients. Hindawi. 2007;1-5.

Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clinical Investigation. 2003;111(12);1805-12.

Muntner P, He J, Hamm L, Loria C, Whetton PK. Renal insufficiency and subsequent death from cardiovascular disease. J AM Soc Nephrol. 2002;13:745-53.

Kumar SB, Shobharani B. Comparative study of hscrp in chronic kidney disease. IOSR J Pharmacy. 2015;5(7):8-12.

Clinical practice guidelines for nutrition in CRF. National kidney foundation. Am J Kidney Dis. 2000;35:1-40.

Soriano S, Gongelez L. CRP and low albumin are predictors of morbidity and cardiovascular events in CKD stage 3-4 patients. J Clinical Nephrol. 2007;67(6):352-7.

Barrett BJ, Parfery PS, Morgan J. Prediction of early death in end stage renal disease patients starting dialysis. Am J Kidney Dis. 1997;29:214-22.

Kaysen GA, Rathore V, Shearer GC. Mechanisms of hypoalbuminemia in hemodialysis patients. Kidney Int. 1995;48:510-6.

Blumenkarntz MJ, Kopple JD, Gutman RA. Methods for assessing nutritional status of patients with renal failure. Am J Clin Nutr. 1980;33:1567-85.

Iseki K. Impact of the initial levels of laboratory variables and survival in chronic dialysis patient. Am J Kidney Disease. 1996;28:541-8.

Abdullah MS, Wild G, Jacob V. Cytokines and the malnutrition of chronic renal failure. Mine Electrolyte Metals. 1997;23:231-42.

Ortega O, Gallar P, Carreno A, Ortiz M, Espejo B, Jimenz J, oliet A. Significance of high C-reactive protein levels in pre-dialysis patients. Nephrol Dial Transplant. 2002;17:1105-9.

Shah NR, Dumles. Hypoalbuminemia a marker of cardiovascular disease in patients with CKD 2-4. Int J Med Sci. 2008;5:366-70.

Walsen M, Frame MD, Ward L. Progression of chronic renal failure in patients with ketoacids following aminoacids. Kidney Int. 1987;32:123-8.

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Published

2017-01-23

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Original Research Articles