C-reactive protein and procalcitonin as markers of mortality in hemodialysis patients: A 2-year prospective study

Objective: We have previously shown in a transversal study that PCT combined to CRP is associated to an altered nutritional status in hemodialysis patients. In a 2-year prospective study, we have assessed the relationship between markers of inflammation or nutrition and mortality. Design: Two-year prospective study, in 61 patients dialyzed in our unit (29 M/32 F, age 63 ± 15 years, on dialysis for 76 ± 94 months, 12 hrs/wk, on high-flux (HF) membrane for 25 patients and low-flux (LF) for 36 patients, without reuse). Kt/V was 1.53 ± 0.30. Setting: Hospital-based dialysis unit. Main Outcome Measure: CRP, PCT, ferritin, albumin, and prealbumin, were measured in 04/99 (T0) and every 6 months thereafter. Interleukin-6 (IL6) and fibrinogen were measured at the start of study. The outcome and the causes of death of patients were noted in 58 patients, 3 patients were lost of follow-up. Results: The mortality (24 deaths) was 42% at 2 years in this hospital based unit. The main causes of mortality were cardiovascular diseases (71%) and infection (17%). Patients were classified according to their CRP (CRP+ if CRP ≥ 5 mg/L; n = 40), and PCT values (PCT + if PCT ≥ 0.5 ng/mL; n = 25). IL6 level was ≥ 10 pg/mL for 95% of the patients. Mortality was higher in the CRP+ group (Kaplan-Meier test P