predictive value of C-reactive protein for some clinical and biochemical disorders in patients with chronic renal failure

ABSTRACT

The present work aimed to study the possible role of inflammatory process in the pathogenesis of anemia, malnutrition. ischemic heart disease, half and half nail sign dyslipidemia and hypoalbuminemia in patients with chronic renal failure under hemodialysis and the predictive value of C-reactive protein [CRP] in these disorders. The subjects of this work comprised of fifty patients with chronic renal failure in the Nephrology unit Benha University Hospital. They were divided into two groups including twenty patients under conservative treatment and thirty patients under regular hemodialysis treatment 10 patients using polysulphone dialyzers and 20 patients using cuprophane dialyzers. In addition ten healthy subjects were used as controls. For all of them the following was done; full medical history, complete clinical examination, hematological parameters [Hb. content, Nt value, complete blood picture, mean corpuscular volume, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration], biochemical tests [blood urea, serum creatinine, serum albumin, serum cholesterol and C-reactive protein] and electrocardiogram. The results showed that CRP level in chronic renal failure patients either under conservative treatment or hemodialysis was elevated [12 +/- 3.980 mg/dL and 11.73 +/- 8.081 mg/dL respectively] as compared to the control group [1.85 +/- 1.1 mg/dL] and p<0.05. There was no significant difference between group with conservative treatment and group with hemodialysis [p>0.05]. CRP level was higher in patients using cuprophane dialyzers than patients using polysulphone dialyzers [14.7 +/- 8.3 mg/dl vs 5.8 +/- 2.3 mg/dL] and p<0.05. Hemoglobin concentration was statistically insignificant between patients dialyzed by euprophane or polysulphone [mean value 8.3 +/- 2.6 gm/dl vs 9.9 +/- 2.6 gm/dl, p>0.05]. CRP level was negatively correlated with serum albumin level in CRF under hemodialysis patients [r=0.409 and p<0.05]. Serum albumin level was significantly higher in patients dialyzed by polysulphone than those dialyzed by cuprophane [mean value 4.11 +/- 0.66 gm/dl vs 3.33 +/- 0.89 gm/dl, p<0.05]. CRP level was not correlated with occurrence of half and half nail sign in hemodialysis patients [r=0.25, p>0.05]. CRP level was not correlated with serum total cholesterol level in hemodialysis patients [r=0.13221, p>0.05] while there was high incidence of ischemic ECG changes in those patients. High CRP levels were associated with by and low body mass index in hemodialysis patients, this signifies that inflammatory process contributes in occurrence of malnutrition in hemodialysis patients. Thus we have concluded that, inflammatory process contributes to anaemia, malnutrition, ischemic heart disease and hypoalbuminemia in hemodialysis patients a C-reactive protein can predict these disorders. The use of biocompatable membranes for dialysis leads to less inflammatory process and consequently better nutrition. state of the patients