Clinical Significance Of High Sensitivity C-reactive Protein In Maintenance Hemodialysis Patients

Background:At present, hemodialysis as one of the renal replacement therapy ways for end-stage renal disease already has been widespread used in clinical practice. The technology has been improved significantly. MHD patient's long-term survival rate remarkable enhancement, but long-term complications of dialysis is still a threat to the survival of dialysis patients and which is an important factor in the quality of MHD patients. There are still more malnutrition, anemia and Cardiovascular complications in MHD patients. Long-term survival rate of MHD patients is still relatively low, cardiovascular complications are the main cause of death, its incidence among the general population is about 10～20 times. The form and function of the heart of uremic patients often change , left ventricular hypertrophy (LVH) and Left ventricular diastolic dysfunction in uremic myocardial damage is the most prominent features, and also is an independent risk factor in affecting the survival of MHD patients. In addition to the primary disease, mainly related to uremia and its changes in hemodynamics, neurohumoral and related metabolic abnormalities in treatment, And in which inflammatory response plays an important role. The relations between Malnutrition, anemia and Cardiovascular complications with the inflammatory response in the body exist of the MHD patients more and more brings to people's attention. The body in the process of inflammation often occur system-response, an important organ dysfunction and liver protein synthesis increase or decrease, this process is known as acute- phase response.To participate in the acute phase response, the plasma protein is knowning as acute-phase proteins(APP), C-reactive protein is an important indicator of inflammation and is the main component of the APP, which can be used as chronic micro-inflammation condition designated object in chronic renal failure and the maintenance hemodialysis patient. High sensitivity C-reactive protein (hs-CRP) is one of C-reactive protein in plasma, By using the ultra-sensitive detective technology, people can accurately detect the low concentrations of C-reactive protein in Clinical Laboratory, which improve the testing sensitivity and accuracy. Hs-CRP is a sensitive index in distinguishing the low-level inflammatory state. In recent years, more and more evidence show that hs-CRP is related to anemia, nutritional status, atherosclerosis and the occurrence of cardiac disease, evolution and development of the pro-inflammatory factor, which is one of the the most powerful prediction factor in the risk of cardiovascular events. This article focused on the impact of hemodialysis (HD) on the high-sensitivity C-reactive protein (hs-CRP); and the relationship between high-sensitivity C-reactive protein (hs-CRP) with anemia, nutritional status and changes in ventricular structure.OBJECTIVE: Discussion the relationship between high-sensitivity C-reactive protein (hs-CRP) with anemia, nutritional status and ventricular structural changes in maintenance hemodialysis patients.METHODS:Fifty-eight maintenance hemodialysis patients were studied. Fasting venous blood samples were collected before dialysis. And the levels of its high-sensitivity C-reactive protein (hs-CRP), hemoglobin (Hb), hematocrit (Hct), transferrin (TF), serum ferritin(SF), serum total protein (TP), albumin (Alb), prealbumin (PA), serum creatinine(Scr), triglyceride (TG), total cholesterol (T-CHOL), Total iron binding capacity(TIBC), serum iron(S-iron) and Parathyroid hormone (PTH)were determined. Post-dialysis blood urea and plasma urea before the next dialysis were recorded to calculate Urea clearance index(KT/V), The dose of rHuEPO per week was recorded, and the relation between hs-CRP and rHuEPO was observed. And two-dimensional color Doppler echocardiography determination of heart left atrial diameter (LAD), left ventricular diameter (LVD), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT) were collected. According to the level of hs-CRP, patients were divided into high group (A group:hs-CRP≥3mg/L) and normal group (B group:hs-CRP <3mg/L); The relationships between hs-CRP and hemoglobin, serum nutritional indicators and ventricular structure were observed.RESULTS:hs-CRP's median is 9.76 mg/L (3.08～75.70 mg/L) in A group, 0.89 mg/L (0.66～2.9 mg/L) in B group, the former was significantly higher than the latter (P = 0.035). There were Hb (94.57±3.79) g/L, ALB (34.26±1.42) g/L in A group, which were lower than B group of Hb (101.38±3.79) g/L, ALB (37.41±1.42) g/L, the two groups compared were significantly different (P<0.01). Ventricular indicators LAD (3.94±0.62) cm, LVD (4.63±0.78) cm, IVST (1.26±0.21) cm, LVPWT (1.32±0.18) cm in A group, which are higher than B group LAD (3.28±0.54) cm , LVD (4.12±0.76) cm, IVST (1.13±0.12) cm, LVPWT (1.01±0.15) cm, and the two groups were significantly different (P <0.05). Linear correlation analysis of the results of hs-CRP with Hb, Alb was significantly negatively correlated, the correlation coefficient r were -0.386 (P = 0.001), -0.487 (P = 0.004), and LAD, LVD, LVPWT positive correlation coefficient of r were 0.2936 (P = 0.028); 0.4755 (P = 0.006); 0.2816 (P = 0.023). Hs-CRP and EPO dose per week was positively correlated, the correlation coefficient r was 0.574 (P = 0.001); Hs-CRP and EPO/HCT ratio was positively correlated, the correlation coefficient r was 0.463 (P = 0.005). The relationship between hs-CRP and T-CHOL was a positive correlation, correlation coefficient r was 0.230 (P = 0.035); The correlation between TG, Scr was not significant, there were no significant differences in indicators between the two groups of age, sex, weight, and Kt / v.CONCLUSIONS:Hs-CRP levels were generally higher in MHD patients (The normal reference value <3mg/l) , hs-CRP levels may reflect the anemia, nutritional status and ventricular structural changes. Hs-CRP predict increased rHuEPO is an ideal therapeutic targets, monitoring of hs-CRP levels might be adjusted to achieve an effective amount of rHuEPO to correct anemia, which had some clinical value. At the same time, high-sensitivity C-reactive protein as one of the most representative symbol in the state of chronic inflammation, which can be used to evaluate the maintenance hemodialysis patients with nutritional status and ventricular structure and may be served as an indirect predictor in determining the prognosis of maintenance hemodialysis patients.