Serum c-reactive protein and nutritional parameters in hemodialysis patients serumski c-reaktivni protein i nutritivni parametri kod

Introduction. Inflammation is the most important factor in the genesis of vascular complication in end stage renal disease. Serum CRP level is a sensitive marker of systemic inflammation, as well as a predisposing factor for cardiovascular and all cause mortality in patients on hemodialysis. Albumin is the negative acute phase protein and its synthesis declines during the inflammation. Patients undergoing hemodialysis have a high prevalence of protein-energy malnutrition, due to reduced protein synthesis and increased degradation. Low serum albumin levels in these patients originate from the complex setting of conditions with systemic inflammatory response as a major cause, malnutrition and overhydratation. The aim of this study was to determine the prevalence of elevated CRP levels in dialysis patients, and to analyse its correlation with serum albumin levels and other parameters of nutritional status. Method. The study included 49 patients on maintenance hemodialysis at the Department of Hemodialysis, Clinic of Nephrology, Military Medical Academy, Belgrade. In order to analyse parameters, blood samples were taken during the AVF puncture and before the second weekly dialyse. The following parameters were determined: serum levels of urea and creatinine before and after the dialysis procedure, C-reactive protein (CRP), hemoglobin, fasting glycemia, total cholesterol, triglycerides, albumins, iron, glycosylated hemoglobin (HbA1c), fasting insulinemia and C-peptide only before the dialysis. Results. We analysed 49 patients on maintenance hemodialysis, 37 (75.5%) males and 12 (24.5%) females with the average age of 56.04±13.93 years. The average duration of the dialysis treatment was 7.37±5 years. High serum CRP levels (more than 3mg/L) was found in 65,3% of patients. Singificantly more diabetic patients were observed in the group with higher CRP levels (n=12) compared to the group with normal CRP levels ( n=3) (p≤0,05). We found negative correlation between CRP values and serum albumin, HbA1c, total cholesterol and triglyceride levels. These correlations didn't reach statistical significance. Conclusion. Our study observed a high rate of inflammation in dialysis patients presenting as high frequency of elevated CRP levels in examined group. Negative correlation between CRP levels and serum albumin, as well as with some other parameters of nutritional status, suggests that chronic inflammation may be the missing link that actually connect protein energy malnutrition with high morbiditiy and mortality rate in these patients.