Abstract: PUB120
Acute Asymptomatic C-Reactive Protein Elevations Predict Short-Term Adverse Events in Patients on Peritoneal Dialysis
Session Information
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Kunin, Margarita, Sheba Medical Center, Tel HaShomer, Tel Aviv District, Israel
- Abu Amer, Nabil, Sheba Medical Center, Tel HaShomer, Tel Aviv District, Israel
- Mini-Goldberger, Sharon, Sheba Medical Center, Tel HaShomer, Tel Aviv District, Israel
- Beckerman, Pazit, Sheba Medical Center, Tel HaShomer, Tel Aviv District, Israel
Background
C-reactive protein (CRP) is a well-established marker of inflammation, increasing in response to both acute and chronic inflammatory conditions. While the long-term effects of chronic CRP elevation have been extensively studied in dialysis patients, the prognostic significance of acute, asymptomatic CRP elevations in these individuals remains unclear. This study aimed to determine whether acute, asymptomatic increases in CRP levels could predict short-term adverse events in patients undergoing peritoneal dialysis (PD).
Methods
Cases of acute serum CRP elevation observed during routine PD patient visits, in the absence of clinical signs of inflammation or infection, were collected. Follow-up analyses were conducted to assess the occurrence of adverse events within one month following the CRP elevation.
Results
CRP elevations associated with adverse events in the subsequent month were significantly higher than CRP elevations without adverse events: for any event - 58.97±58.29 mg/l versus 31.67±24.57 mg/l (p=0.004), for severe event - 70.28±62.26 mg/l versus 31.16±24.67 mg/l (p=0.001), for peritonitis - 54.95±28.28 mg/l versus 37.81±39.96 mg/l (p=0.024), and for hospitalization - 81.03±72.27 mg/l versus 35.79±32.91 mg/l (p=0.010). Acute CRP elevations above 50 mg/L were strongly associated with increased risk of short-term adverse events: Odds ratio (OR) was 3.119 (p=0.004) for any event, 4.727 (p=0.000) for severe event, 3.091 (p= 0.038) for PD-related peritonitis, 5.023 (p=0.017) for hospitalization. Receiver operating characteristic (ROC) curve analysis demonstrated AUC 0.737 (95% CI: 0.606–0.869, p=0.007) for PD-related peritonitis, 0.771 (95% CI: 0.639–0.902, p=0.005) for hospitalization and 0.768 (95% CI: 0.664–0.873, p<0.001) for severe adverse event. Multivariate analysis confirmed that CRP levels above 50 mg/L independently predicted short-term adverse outcomes: OR was 2.769 (p=0.016) for any event and 4.065 (p=0.002) for severe adverse event.
Conclusion
Acute serum CRP elevations exceeding 50 mg/L in asymptomatic PD patients are strongly associated with an increased risk of short-term adverse events, including hospitalization and PD-related peritonitis. These findings suggest that routine CRP monitoring during follow-up visits may help identify patients at higher risk and facilitate timely interventions.