Abstract 3145: Malnutrition and Chronic Inflammation Interactively Increased Cardiovascular and All-Cause Mortality Risk in End-Stage Renal Disease Patients - 10-Year Follow-Up Study from Inducting Dialysis Therapy
Malnutrition and chronic inflammation are increasingly associated with cardiovascular (CV) morbidity. We examined a prognostic value of combining serum albumin and C-reactive protein (CRP) levels for CV and all-cause mortality in end-stage renal disease (ESRD) patients from inducting hemodialysis (HD) therapy. Serum albumin and CRP were measured consecutively in 1,460 ESRD patients at starting HD therapy. Patients were divided into qurtiles according to albumin levels; Q1: < 3.1 mg/dl, Q2: 3.2–3.5mg/dl, Q3: 3.6 –3.8mg/dl and Q4: > 3.9mg/dl, and CRP levels; Q1: <0.08 mg/dl, Q2: 0.09 – 0.23 mg/dl, Q3: 0.24 – 0.75mg/dl and Q4: >0.76mg/dl, respectively. They were followed up for 10 years. On Cox analysis, hazard ratio (HR) of decreased albumin levels was 2.58 (95%CI 1.59 – 4.19 for Q1 vs. Q4, p=0.0004) for CV mortality and 3.69 (95%CI 2.62–5.19 for Q1 vs. Q4, p=0.0001) for all-cause mortality, respectively. Similarly, HR of elevated CRP levels was 5.78 (95%CI 3.03–10.98) for CV mortality and 4.36 (95%CI 3.02– 6.32) for all-cause mortality, respectively (p=0.0001 for both). In the setting of combination of albumin and CRP levels, the risk of CV mortality was 17.0-fold in Q1 of albumin and Q4 of CRP compared with Q4 of albumin and Q1 of CRP (p=0.0023). Similarly, the risk of mortality was 33.7-fold (p=0.0001). These variables were significant after adjustment for other CV risk factors (Figure⇓). Malnutrition and chronic inflammation might have interactively increased CV and all-cause mortality risk in ESRD patients at inducting HD therapy. The combined measurements of albumin and CRP is simple and useful for risk stratification in this population.