C-reactive protein and albumin as predictors of all-cause and cardiovascular mortality in chronic kidney disease
C-reactive protein and albumin as predictors of all-cause and cardiovascular mortality in chronic kidney disease
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DOI：
10.1111/j.1523-1755.2005.00455.x
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发表时间：
2005-08-01
影响因子：
19.6
通讯作者：
Sarnak, MJ
中科院分区：
文献类型：
--
作者：
Menon, V;Greene, T;Sarnak, MJ
C-反应蛋白和白蛋白作为慢性肾脏疾病全因和心血管死亡率的预测因子高C反应蛋白（CRP）和低白蛋白血症与肾衰竭患者死亡风险增加相关。目前评价CRP、白蛋白与慢性肾脏病（CKD）3期和4期患者预后之间关系的数据有限。肾脏疾病饮食改良（MDRD）研究是一项于1989年至1993年进行的随机对照试验。在基线时采集的冷冻样本中测量CRP。从国家死亡指数中获得截至2000年12月31日的生存状况和死亡原因。多变量考克斯模型用于研究CRP [分为高CRP ≥ 3.0 mg/L（N = 414）和低CRP < 3.0 mg/L（N = 283）]和血清白蛋白与全因和心血管死亡率的关系。中位随访时间为125个月，全因死亡率为20%（N = 138），心血管死亡率为10%（N = 71）。在调整人口统计学、心血管和肾脏疾病因素的多变量分析中，高CRP（HR，95% CI = 1.56，1.07-2.29）和血清白蛋白（HR = 0.94/0.1 g/dL增加，95% CI = 0.89-0.99）是全因死亡率的独立预测因子。高CRP（HR 1.94，95%CI 1.13-3.31）是心血管死亡的独立预测因子，而血清白蛋白（HR 0.94，95%CI 0.87-1.02）不是。在CKD 3期和4期测量的高CRP和低白蛋白都是全因死亡率的独立风险因素。高CRP，而不是血清白蛋白，是心血管死亡的危险因素。这些结果表明，高CRP和低白蛋白血症在CKD中提供相互独立的预后信息。
C-reactive protein and albumin as predictors of all-cause and cardiovascular mortality in chronic kidney disease.Background. High C-reactive protein (CRP) and hypoalbuminemia are associated with increased risk of mortality in patients with kidney failure. There are limited data evaluating the relationships between CRP, albumin, and outcomes in chronic kidney disease (CKD) stages 3 and 4.Methods. The Modification of Diet in Renal Disease (MDRD) Study was a randomized controlled trial conducted between 1989 and 1993. CRP was measured in frozen samples taken at baseline. Survival status and cause of death, up to December 31, 2000, were obtained from the National Death Index. Multivariable Cox models were used to examine the relationship of CRP [stratified into high CRP >= 3.0 mg/L (N = 414) versus low CRP < 3.0 mg/L (N = 283)], and serum albumin, with all-cause and cardiovascular mortality.Results. Median follow-up time was 125 months, all-cause mortality was 20% (N = 138) and cardiovascular mortality was 10% (N = 71). In multivariable analyses adjusting for demographic, cardiovascular and kidney disease factors, both high CRP (HR, 95% CI = 1.56, 1.07-2.29) and serum albumin (HR = 0.94 per 0.1 g/dL increase, 95% CI = 0.89-0.99) were independent predictors of all-cause mortality. High CRP (HR 1.94, 95% CI 1.13-3.31), but not serum albumin (HR 0.94, 95% CI 0.87-1.02), was an independent predictor of cardiovascular mortality.Conclusion. Both high CRP and low albumin, measured in CKD stages 3 and 4, are independent risk factors for all-cause mortality. High CRP, but not serum albumin, is a risk factor for cardiovascular mortality. These results suggest that high CRP and hypoalbuminemia provide prognostic information independent of each other in CKD.