Original InvestigationDialysis TherapySerum Albumin, C-Reactive Protein, Interleukin 6, and Fetuin A as Predictors of Malnutrition, Cardiovascular Disease, and Mortality in Patients With ESRD
Section snippets
Methods
One hundred seventy-six patients with ESRD (114 men; age, 54 ± 12 years; range, 23 to 70 years) were examined close to the start of renal replacement therapy. On average, blood samples were obtained approximately 1 month before the start of renal replacement therapy in 128 patients and 8 days after the start of renal replacement therapy in 48 patients; however, because levels of the 4 investigated biomarkers did not differ between these 2 groups, data were analyzed in all 176 patients. Patients
Patient Characteristics
Characteristics of enrolled patients are listed in Table 1. Sixty patients had a history of CVD (34%), and 50 patients (30%) were malnourished. As expected, mean age was older in patients with CVD (60 ± 8 versus 50 ± 12 years; P < 0.01) and PEM (60 ± 9 versus 50 ± 13 years; P < 0.01) than in patients without these complications. Moreover, patients with CVD, compared with patients without CVD, had lower S-Alb levels (P < 0.01) and greater median hs-CRP (1.35 versus 0.45 mg/dL; P < 0.01) and IL-6
Discussion
In the present comparative analysis of 4 biomarkers (S-Alb, hs-CRP, IL-6, and fetuin A), only IL-6 level among the 4 biomarkers predicted PEM, CVD, and mortality (Table 2). In the ROC analysis, an AUC between 0.7 and 0.8 is considered to represent a “fair predictor,”16 and this was seen for only IL-6 level. Previous studies showed that S-Alb level and inflammation predict PEM, CVD, and outcome,4, 17, 18, 19and fetuin A level is reported to predict CVD and outcome11 in patients with ESRD. In the
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Support and disclosure: This study was supported by grants from the Baxter Healthcare Corp, Deerfield, IL, and Söderbergh Foundation (P.S.). Bengt Lindholm is employed by Baxter Healthcare, Deerfield, IL.
Originally published online as doi:10.1053/j.ajkd.2005.09.014 on November 7, 2005.