Seasonal variation of C-reactive protein and atherosclerotic cardiovascular events in hemodialysis patients

Figures & data

TABLE 1. Scoring for atherosclerotic cardiovascular diseases by the modified index of co-existing diseases

Score	Coronary artery disease	Cerebral vascular events	Peripheral vascular disease
0	Absence of disease in past or present by history and negative cardiac catheterization within the past year	Absence of disease in past or present by history	Absence of disease in past or present by history
1	Past diagnosis of CAD or myocardial infarction (MI); or evidence of past MI by electrocardiogram (ECG) or echocardiography; or angiographically defined CAD; or history of coronary neovascularization procedures and Past 3 months free of angina, acute MI, or ischemia by ECG or other diagnostic tests	Past diagnosis of cerebral vascular events (CVE), symptomatic carotid stenosis, or transient ischemic attacks, or history of carotid endarterectomy or incidental brain computer tomography findings compatible with CVE and Past 3 months free of stroke or TIA diagnosis or symptoms	Diagnosis of peripheral vascular disease (PVD) or aortic aneurysm; history of amputation of digits or extremities secondary to PVD, peripheral arterial bypass or aortic aneurysm repair and Past 3 months free of intermittent claudication, recurrent cellulitis, skin infections, toe gangrene, or pain at rest secondary to PVD
2	If any of the following in the past 3 months: Stable or exertional angina, angina during HD, acute MI, or ischemia by ECG or other diagnostic tests	If any of the following in the past 3 months: Stroke or TIA diagnosis or symptoms	If any of the following in the past 3 months: Intermittent claudication, recurrent cellulitis, skin infections, toe gangrene, or pain at rest secondary to PVD

TABLE 2. Demographic characteristics of study population at baseline

Female gender (%)	37.1
Age (year)	58 ± 14
Duration of dialysis (months)	69 ± 53
BMI (kg/m^2)	26.8 ± 4.9
SBP (mmHg)	130 ± 30
DBP (mmHg)	79 ± 13
Diabetes mellitus (%)	19.3
Hypertension (%)	62
Smokers (%)	21
Regular exercise (%)	7
Patients on acetylsalicylic acid (%)	14.6
Patients on statin treatment (%)	14
Erythropoietin users (%)	84
ICED Score
0 point (%)	69.4
1 point (%)	19.4
2 point (%)	11.3

Notes: Data are presented as mean ± SD. BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure.

TABLE 3. Seasonal demographic and laboratory data

	Winter	Spring	Summer	Autumn
BMI (kg/m^2)	26.8 ± 4.9	26.8 ± 4.9	26.6 ± 4.9	26.7 ± 4.8
SBP (mmHg)	130 ± 30	132 ± 31	128 ± 30	129 ± 30
DBP (mmHg)	79 ± 13	81 ± 13	78 ± 13	78 ± 13
ICED Score
0 point (%)	73	73	69.8	69.8
1 point (%)	17.5	20.6	22.2	20.6
2 point (%)	7.9	4.8	6.3	8.1
Kt/V	1.4 ± 0.3	1.3 ± 0.3	1.3 ± 0.3	1.4 ± 0.3
URR (%)	66 ± 8^#	64 ± 9	67 ± 6	65 ± 10
hsCRP (mg/L)	4.17	4.17	4.57	4.17
Hb (g/dL)	11.5 ± 1.5	11.6 ± 1.4	11.4 ± 1.3	11.5 ± 1.4
Serum albumin (g/dL)	4.0 ± 0.5	4.1 ± 0.4	4.1 ± 0.3	4.3 ± 0.3
Total cholesterol (mg/dL)	194 ± 60		181 ± 54^†
Triglyceride (mg/dL)	199 ± 110		208 ± 157
HDL-cholesterol (mg/dL)	41 ± 11		39 ± 12
LDL-cholesterol (mg/dL)	110 ± 38		96 ± 29^†
Calcium (mg/dL)	9.1 ± 0.9	9.0 ± 1.0	9.3 ± 0.8	9.2 ± 0.8
Phosphorus (mg/dL)	5.0 ± 1.5	5.5 ± 2.0	5.2 ± 1.9	5.2 ± 1.7
PTH (ng/mL)	599 ± 557		556 ± 576

Notes: Data are presented as mean ± SD unless otherwise mentioned. *Data are presented as geometric mean. hsCRP, high-sensitive C-reactive protein; URR, urea reduction ratio; PTH, parathormone.

^#p < 0.05 versus spring,

*p < 0.001 versus winter and spring,

^†p < 0.01 versus winter.

TABLE 4. Seasonal distribution of atherosclerotic cardiovascular events

	ACVD mortality	ACVD morbidity	ACVD events combined
Winter (n = 62)	1 (1.6%)	0	1 (1.6%)
Spiring (n = 61)	1 (1.6%)	0	1 (1.6%)
Summer (n = 60)	2 (3.3%)	4 (6.6%)	10 (10%)
Autumn (n = 54)	1 (1.8%)	3 (5.4%)	4 (7.1%)

Notes: Data are presented as number and percentage. ACVD, atherosclerotic cardiovascular disease.

Parfrey PS. Cardiac disease in dialysis patients: Diagnosis, burden of disease, prognosis, risk factors and management. Nephrol Dial Transplant. 2000;15(Suppl. 5):58–68.

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