Kidney Int. 2007; published online ahead of print

Higher levels of C reactive protein (CRP) are independently associated with adverse outcomes in peritonitis associated with peritoneal dialysis (PD), according to Canadian researchers.

In a prospective study of 209 PD patients who suffered an episode of peritonitis, Nadia Y. Zalunardo, MD, of the University of British Columbia in Vancouver, and her colleagues measured serum CRP levels at baseline and three weeks after initiation of peritonitis treatment. After adjusting for age, gender, diabetes, duration of renal replacement therapy, and causative organism, patients in the second, third, and highest quartile of CRP levels at diagnosis had a 1.57, 2.73, and 3.38 times higher risk of adverse short-term outcome (switch to hemodialysis, death, persistent infection beyond planned therapy duration, and relapse) than patients in the first quartile. In patients who met clinical and laboratory criteria for resolution of peritonitis three weeks after diagnosis, those with higher CRP levels (above 23 mg/L) had a 1.79 times higher risk of long-term adverse outcome (subsequent peritonitis episode or death) than patients with CRP levels of 23 mg/L or less.

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“Serial measurement of this marker during the course of peritonitis may facilitate earlier identification of individuals at greater risk of complications,” the authors concluded. The first, second, third, and fourth quartiles corresponded to CRP levels less than 23, 23-56, 57-126, and 127-288 mg/L.