Abstract
Introduction: Chronic kidney disease (CKD) is worldwide a major public health problem, with increasing incidence, prevalence, high cost and poor outcomes. Highly sensitive CRP (hsCRP) has been introduced as a predictor of cardiovascular events in cardiovascular medicine. It has been noted that hsCRP can bind to damaged endothelial cells, activate the complement system, promote foam cell formation, aggregate low-density lipoprotein, and stimulate tissue factor production by monocytes. hsCRP can also induce adhesion molecules in endothelial cells and deposit along the walls of glomerular capillaries, suggesting that hsCRP may participate in the pathogenesis of glomerulosclerosis and atherosclerosis.
Materials and Methods: This cross section observational study was conducted in 104 patients of End Stage Renal Disease attending OPD of Department of Medicine, MGM Medical College and MY Hospital, Indore, MP, for conservative treatment from April 2017 to March 2018.
Results: In our study, the mean level of hsCRP was 17.58±8.5 mg /dl. In 93.4% of patients hsCRP was raised above 5 mg/dl and in 46.2 % of subjects, hsCRP was >20 mg/dl. Prevalence of Heart Failure, CVA, CAD, Retinopathy, and Neuropathy were 18.3%, 3.8%, 2.9%, 26.9%, and 5.7% patients respectively. There was no significant correlation between hsCRP level and heart failure, CVA, CAD, and Retinopathy, and observed p values were 0.994, 0.476, 0.246, and 0.287 respectively.
Conclusions: The present study shows excess inflammation and oxidative stress in the CKD patients, in form of raised hsCRP in 93.4% of patients. As our aim was to find out any correlation between the serum hsCRP level, and micro and macro vascular complications in CKD patients but significant correlation of fore-mentioned complications with hsCRP level could not be obtained in our study.
Keywords: Chronic Kidney Disease, hsCRP, macro and micro vascular complication.
References
- S. Renal Data System: 2009 Annual data report. Section A: incidence of reported ESRD. Available at: http://www.usrds.org/2009/ref/A_Ref_09.pdf. Accessed December 17, 2010.
- Mani MK. The management of end-stage renal disease in India. Artif Organs. 1998;22:182-186.
- Agarwal SK, Dash SC, Irshad M, et al. Prevalence of chronic renal failure in adults in Delhi, India. Nephrol Dial Transplant. 2005;20:1638-1642.
- Chiang CE, Wang TD, Li YH, et al. 2010 guidelines of the Taiwan Society of Cardiology for the management of hypertension. J Formos Med Assoc 2010;109:740-73.
- Cermak J, Key NS, Bach RR, et al. C-reactive protein induces human peripheral blood monocytes to synthesize tissue factor. Blood 1993;82:513-20.
- Pepys MB, Rowe IF, Baltz ML. C-reactive protein: binding to lipidsand lipoproteins. Int Rev ExpPathol 1985;27:83-111.
- Nakagomi A, Freedman SB, Geczy CL. Interferon-gamma and lipopolysaccharide potentiate monocyte tissue factor induction by C reactive protein: relationship with age, sex, and hormone replacement treatment. Circulation 2000;101:1785-91.
- Nakahara C, Kanemoto K, Saito N, et al. C-reactive protein frequently localizes in the kidney in glomerular diseases. Clin Nephrol 2001;55:365-70.
- Coresh J, Wei GL, McQuillan G, et al. Prevalence of high blood pressure and elevated serum creatinine level in the United States: findings from the third National Health and Nutrition Examination Survey (1988-1994). Arch Intern Med 2001;161: 1207-16.
- Serum C-reactive protein levels in pre-dialysis chronic kidney disease patients in southern Nigeria Oluseyi A Adejumo, 2016.
- Rifkin DE, Sarnak MJ (2009) Does inflammation fuel the fire in CKD? Am J Kidney Dis 53: 572–575.
- Qian Y, Feldman E, Pennathur S, Kretzler M, Brosius FC 3rd (2008) From fibrosis to sclerosis: mechanisms of glomerulosclerosis in diabetic nephropathy. Diabetes 57: 1439–1445.
- Dalla Vestra M, Mussap M, Gallina P, Bruseghin M, Cernigoi AM, et al. (2005) Acute-phase markers of inflammation and glomerular structure in patients with type 2 diabetes. J Am Soc Nephrol 16 suppl 1:78–82.
- Navarro JF, Milena FJ, Mora C, Leon C, Garcia J Renal proinflammatory cytokine gene expression in diabetic nephropathy: 88 effect of angiotensin- converting enzyme inhibition and pentoxifylline administration. Am J Nephrol 26: 562–570.
- USRDS, annual data report: atlas of end stage renal disease in the United States. Bethesda, Md: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2009.
- Roderick PJ, Atkins RJ, Smeeth L, et al. CKD and mortality risk in older people: a community-based population study in the United Kingdom. Am J Kidney Dis. 2009;53:950-960.
- Lindeman RD, Tobin J, Shock NW. Longitudinal studies on the rate of decline in renal function with age. J Am Ger Soc. 1985;33:278-285.
- Sumanth kumar B, Dr. Shobharani. B, Comparative Study of hsCRP in Chronic Kidney Disease,2015.
- Sanjin Rački, C reactive Protein Is a Strong Predictor of Mortality in Hemodialysis Patients, 2009.
Corresponding Author
Dr Shiv Shankar Badole, MD Medicine
Senior Resident, PG Boys Hostel, MGM Department of Medicine, MGM Medical College, Indore, MP, India
DOI: https://dx.doi.org/10.18535/jmscr/v7i9.37
