High-sensitivity C-reactive Protein as a Marker of Future Cardiovascular Events in Chronic Kidney Disease Stage-5 Patients
Published: August 1, 2020 | DOI: https://doi.org/10.7860/JCDR/2020/44704.13937
Nisha Abraham, C Beena, Sangeetha Merrin Varghese
1. Assistant Professor, Department of Biochemistry, Believers Church Medical College Hospital, Thiruvalla, Kerala, India.
2. Professor and Head, Department of Biochemistry, Government Medical College, Ernakulam, Kerala, India.
3. Assistant Professor, Department of Community Medicine, Believers Church Medical College Hospital, Thiruvalla, Kerala, India.
Correspondence
Dr. Nisha Abraham,
Department of Biochemistry, Believers Church Medical College Hospital, Kuttappuzha, Thiruvalla-689103, Kerala, India.
E-mail: nishakokat@gmail.com
Introduction: Chronic Kidney Disease (CKD) has been recognised as a worldwide health threat and understanding its complex patho-physiological mechanisms could go a long way in taking care of patients with CKD. One of the most important causes for mortality in End Stage Renal Disease (ESRD) patients is Cardiovascular Disease (CVD). ESRD is a low grade chronic inflammatory state, suspected to promote atherosclerosis.
Aim: To determine, if there is any association between elevated High-sensitivity C-Reactive Protein (hs-CRP) and development of future cardiovascular events in stage-5 CKD patients.
Materials and Methods: Forty-five CKD stage-5 patients were included in the study, after ruling out patients with established CVD. According to categorisation proposed by the American Heart Association for the cut-off value of hs-CRP-value (3 mg/L), patients were divided into two groups. Those who had hs-CRP more than 3 mg/L were considered to have ‘elevated hs-CRP’ and those who had a value 3 mg/L and below were considered to have ‘normal hs-CRP’ levels. These patients were followedup monthly, for a period of one year to record any occurrence of cardiovascular events (coronary events/cerebrovascular accidents/peripheral occlusive vascular disease). Statistical Package for the Social Sciences (SPSS) 16.0 was used for analysis. Chi-square test and Mann-Whitney U-test were used for statistical comparison between the groups and a p-value of 0.05 or less was considered to be statistically significant. Receiver Operating Characteristic (ROC) curve was also plotted to determine the cut-off value for hs-CRP based on the occurrence of any cardiovascular event.
Results: Baseline hs-CRP level was more than 3 mg/L in 42% of patients. Among those who had elevated hs-CRP, 78.9% of patients developed cardiovascular events during the follow-up period. This signifies a strong association between elevated hsCRP and CVD in ESRD patients. The hs-CRP cut-off point of 3 mg/L was obtained from ROC curve.
Conclusion: There was a significant association between elevated hs-CRP and development of cardiovascular events in ESRD patients. Hence, hs-CRP can be used as a marker of future cardiovascular events in CKD stage-5 patients.
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