Comparison of Inflammatory Markers in the Diagnosis of Metabolic Syndrome in Hemodialysis Patients: A Multicenter Observational Study

Abstract

Objective

The purpose of this study is to observe the correlation between high sensitivity C-reactive protein (hs-CRP) and metabolic syndrome (MetS) in hemodialysis patients, determine its optimal cut-off point value, and compare the diagnostic ability of different inflammatory markers for MetS.

Methods

This cross-sectional study finally included 860 long-term hemodialysis patients (male 524, average age 61.5 years) from seven dialysis centers in Shanghai, China. The International Diabetes Federation metabolic syndrome guidelines were used to define MetS, including high waist circumference, elevated blood pressure, elevated fasting blood glucose, elevated triglycerides, and reduced HDL cholesterol. Serum hs-CRP was determined by the immunonephelometric assay. The association with MetS was observed according to the quartile of inflammatory markers, and then the optimal cut-off point value of the hs-CRP was determined by ROC analysis.

Results

The overall prevalence of MetS was 55.1% (46.6% in males and 68.5% in females). In the final logistic regression model, there was a significant, graded positive association between hs-CRP and MetS (p for trend = 0.010). The traditional inflammatory markers leukocytes, neutrophils, lymphocytes, monocytes and neutrophil-to-lymphocyte ratio (NLR) were not associated with MetS. The results of the ROC analysis showed that the optimal cut point value of hs-CRP for the diagnosis of MetS was 1.58 mg/L. In the components of MetS and hs-CRP was significantly positively associated with high waist circumference, elevated TG and low HDL (p < 0.05).

Conclusion

The increase in hs-CRP concentration is significantly associated with the risk of MetS, and the diagnostic ability of hs-CRP for MetS is better than traditional inflammatory markers.

Keywords:

• metabolic syndrome
• inflammatory markers
• high sensitivity C-reactive protein
• hemodialysis

Data Sharing Statement

The data that support the findings of this study are not publicly available due to their containing information that could compromise the privacy of research participants but are available from corresponding author (Q.G.) upon reasonable request.

Statement of Ethics

The study was approved by the Ethics Committee of Shanghai University of Medicine and Health Sciences and the methods were carried out in accordance with the principles of the Declaration of Helsinki. All participants were informed and signed consent prior to enrollment in the study.

Acknowledgments

We thank all the medical staff at the multi-center dialysis for their generous technical assistance and guidance. We also thank all the study participants for their kind participation and cooperation.

Author Contributions

P.S., Y.Z. and H.Z. contributed equally to this work and should be considered the co-first authors. Q.G., C.Y., P.S., Y.Z. and H.Z. conceived the concept and design of the study. All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article has been submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors have no conflicts of interest to declare.

Additional information

Funding

This work was funded by the National Natural Science Foundation of China (No. 82172552).