The effect of single and repeatedly high concentrations of C-reactive protein on cardiovascular and non-cardiovascular mortality in patients starting with dialysis

Background. Single measurements of C-reactive protein (CRP) predict cardiovascular mortality in dialysis patients. However, CRP can be temporarily elevated due to infections. Therefore, we investigated the effect of single and repeatedly high concentrations of CRP on cardiovascular and non-cardiovascular mortality in incident dialysis patients. Methods. In the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), patients starting with dialysis were enrolled between 1997 and 2002. From 635 patients, plasma CRP concentrations were determined at 3 and 6 months of follow-up. Concentrations > 10 mg/l were regarded as 'high'. Patients were followed until time of death, or censored at the end of follow-up (1 May 2004). Cox regression models were performed to compare mortality between patients with repeatedly low CRP, with varying CRP and with repeatedly high CRP. Results. At the end of follow-up, 247 patients had died, of which 107 patients died of cardiovascular disease (47.8%). Patients with low CRP3 months and high CRP6 months were at increased cardiovascular [adjusted hazard ratio (HR): 2.59, 95% CI: 1.25-5.37] and non-cardiovascular (adjusted HR: 2.18, 95% CI: 1.11-4.28) mortality risk compared with patients with low CRP on both occasions. Moreover, patients with high CRP on both occasions had a higher cardiovascular (adjusted HR: 1.51, 95% CI: 0.72-3.18) and non-cardiovascular (adjusted HR: 2.25, 95% CI: 0.96-5.28) mortality risk than patients with high CRP3 months and low CRP6 months. Conclusions. Single and repeatedly high concentrations of CRP (> 10 mg/l) are related to both cardiovascular and non-cardiovascular mortality in dialysis patients. A high CRP concentration, therefore, has implications for the treatment of cardiovascular as well as non-cardiovascular disease.