Inflammatory markers as mortality predictors in continuous ambulatory peritoneal dialysis patients

Figures & data

Table 1. Demographic variables and diagnosis.

Parameter	Value
Sex
Men	57
Women	30
Age (years)^a	62.9 (10.6)
iTime on dialysis (months)^b	30 (15–49)
Kidney disease^c
Nephrosclerosis	40.2 (35)
Diabetic nephropathy	32.2 (28)
Chronic interstitial nephropathy^d	12.6 (11)
Chronic glomerulonephritis	8.0 (7)
Polycystic kidney disease	3.5 (3)
Unknown	3.5 (3)

Notes: ^aMean (SD).

^bMedian (interquartile value).

^cPercentage (count).

^dChronic interstitial nephropathy includes Balkan endemic nephropathy, chronic interstitial nephritis and chronic pyelonephritis.

Table 2. Clinical and laboratory data and inflammatory parameters.

Parameters	Value
BMI (kg/m^2)^a	24.7 (3.9)
Residual urine output (mL)^b	500 (300–1000)
Ultrafiltration (mL)^b	1100 (800–1300)
MAP (mmHg)^a	96 (13)
Congestive heart failure (CHF)^c	12.6 (11)
Ischemic heart disease (IHD)^c	22.9 (20)
Cerebrovascular insult (CVI)^c	8.0 (7)
Number of peritonitis^b	1 (0–3)
KT/V^a	2.09 (0.44)
∑Ccr (L/1.73 m^2)^a	66.8 (16.3)
Hemoglobin (g/L)^a	110.9 (12.1)
Urea (mmol/L)^a	18.5 (4.9)
Creatinine (µmol/L)^a	777 (226)
Calcium (mmol/L)^a	2.28 (0.18)
Phosphate (mmol/L)^a	1.56 (0.35)
Albumin (g/L)^a	31.5 (3.6)
iPTH (pg/ml)^b	235 (144–326)
Leukocytes (×10^9/L)^a	8.17 (2.31)
ESR (mm/h)^b	64 (44–92)
Fibrinogen (g/L)^a	6.2 (1.5)
hs-CRP (mg/L)^b	5.6 (1.8–10.7)
SAA (mg/L)^b	6.69 (3.30–18.90)

Notes: KT/V, dialysis dose; Ccr, total weekly creatinine clearance; MAP, mean arterial pressure; BMI, body mass index; iPTH, intact parathyroid hormone; ESR, erythrocyte sedimentation rate; hs-CRP, high sensitive C-reactive protein; SAA, serum amyloid-A.

^aMean (SD).

^bMedian (interquartile value).

^cPercentage (count).

Table 3. Significant differences among variables in CAPD patients grouped by sex (t-test).

Variables	Men	Women	p
Creatinine (µmol/L)	818 (240)	697 (176)	<0.01
Urea (mmol/L)	19.4 (4.6)	16.6 (5.1)	<0.05
KT/V	1.98 (0.45)	2.31 (0.35)	<0.01

Notes: p, significance of coefficient; KT/V, dialysis dose.

Table 4. Significant differences among variables in CAPD patients grouped by cardiovascular morbidity.

Variables	With CVI	Without CVI	Test	p
Cerebrovascular insut (CVI)
Albumin (g/L)	27.4 (3.6)	31.9 (3.4)	t-Test	<0.05
Urea (mmol/L)	13.5 (4.4)	18.9 (4.8)	t-Test	<0.05
hs-CRP (mg/L)	17.5 (11.6)	10.1 (4.8)	Mann–Whitney U test	<0.05
Congestive heart disease (CHF)
MAP (mmHg)	104 (12)	95 (13)	t-Test	<0.05
Fibrinogen (g/L)	7.1 (1.3)	6.0 (1.5)	Mann–Whitney U test	<0.05

Notes: p, significance of coefficient; hs-CRP, high sensitive C-reactive protein; MAP, mean arterial pressure.

Table 5. Significant correlations among inflammatory markers in the analyzed CAPD patients.

Variables	SAA	hs-CRP	Fibrinogen	ESR
hs-CRP	ρ = 0.62 p < 0.01
Fibrinogen	ρ = 0.69 p < 0.01	ρ = 0.57 p < 0.01
ESR	ρ = 0.49 p < 0.01	ρ = 0.42 p < 0.01	ρ = 0.65 p < 0.01
Leukocytes	ρ = 0.21 p < 0.05	ρ = 0.30 p < 0.01	r = 0.31 p < 0.01	r = 0.27 p < 0.05

Notes: SAA, serum amyloid-A; hs-CRP, high sensitive C-reactive protein; ESR, erythrocyte sedimentation rate; ρ, Spearman correlation coefficient; r, Pearson correlation coefficient; p, significance of coefficient.

Table 6. Significant correlations among inflammatory markers and clinical and laboratory variables in the analyzed CAPD patients.

Variables	SAA	Hs-CRP	Fibrinogen	ESR	Leukocytes
Hemoglobin	n.s.	n.s.	n.s.	ρ = −0.27 p < 0.05	n.s.
Phosphate	n.s.	n.s.	r = 0.22 p < 0.05	n.s.	n.s.
Albumin	ρ = −0.29 p < 0.01	ρ = −0.29 p < 0.01	r = −0.28 p < 0.01	n.s.	r = −0.23 p < 0.05

Notes: SAA, serum amyloid-A; hs-CRP, high sensitive C-reactive protein; ESR, erythrocyte sedimentation rate; n.s., non-significant; ρ, Spearman correlation coefficient; r, Pearson correlation coefficient; p, significance of coefficient.

Table 7. Univariate analysis selected the following potential mortality predictors (p < 0.10).

Variable	Hazard ratio (95% CI)	p
Age (years)	1.06 (1.02–1.11)	<0.01
Months on dialysis	1.01 (0.99–1.02)	0.07
Residual urine output	0.99 (0.99–1.00*)	0.02
CVI	6.31 (2.62–15.18)	<0.01
KT/V	0.46 (0.20–1.06)	0.07
Urea	0.92 (0.85–0.99)	0.03
Albumin	0.90 (0.83–0.98)	0.02
SAA	1.01 (1.00–1.02)	<0.01
hs-CRP	1.02 (1.00*–1.03)	<0.01
Fibrinogen	1.34 (1.09–1.65)	<0.01
ESR	1.01 (1.00*–1.02)	0.01

Notes: Hazard ratio, Exp(B); 95% CI, 95% confidence interval of Exp(B); p, significance of coefficient, *, >1.00; CVI, cerebrovascular insult; KT/V. dialysis dose; SAA, serum amyloid-A; hs-CRP, high sensitive C-reactive protein; ESR, erythrocyte sedimentation rate.

Table 8. Multivariate analysis separately for four models: SAA, hs-CRP, fibrinogen, and ESR.

Model	Variables	Hazard ratio (95% CI)	p
SAA	Age	1.06 (1.02–1.11)	<0.01
	CVI	5.84 (2.32–14.71)	<0.01
	SAA	1.01 (1.00*–1.02)	<0.01
hs-CRP	Age	1.06 (1.01–1.10)	<0.01
	CVI	5.35 (2.08–13.73)	<0.01
	hs-CRP	1.02 (1.00*–1.03)	0.03
Fibrinogen	Age	1.06 (1.02–1.11)	<0.01
	CVI	5.26 (1.89–14.63)	<0.01
	Months on dialysis	1.01 (1.00–1.03)	0.03
	Fibrinogen	1.41 (1.12–1.78)	<0.01
ESR	Age	1.05 (1.01–1.10)	<0.01
	CVI	6.06 (2.28–16.04)	<0.01
	Residual diuresis	0.99 (0.99–1.00^**)	0.02
	ESR	1.01 (1.00*–1.03)	<0.01

Notes: Hazard ratio, Exp(B); 95% CI, 95% confidence interval of Exp(B); p, significance of coefficient; *, >1.00; **, <1.00; SAA, serum amyloid-A; hs-CRP, high sensitive C-reactive protein; ESR, erythrocyte sedimentation rate; CVI, cerebrovascular insult.

Table 9. Multivariate analysis – all inflammatory factors together.

Variables	Hazard ratio (95% CI)	p
Age (years)	1.06 (1.02–1.11)	<0.01
CVI	5.83 (2.31–14.68)	<0.01
SAA	1.01 (1.00*–1.03)	<0.01

Notes: Hazard ratio, Exp(B); 95% CI, 95% confidence interval of Exp(B); p, significance of coefficient; *, >1.00; CVI, cerebrovascular insult; SAA, serum amyloid-A.