‘’TO EVALUATE, CRP AS A MARKER FOR CHRONIC KIDNEY DISEASE PATIENTS’’

Main Article Content

Dr Janhvi Mishra
Dr. Priyanka Singh
Dr Kshama Shrivastava

Keywords

C-Reactive Protein, Chronic Kidney Disease, Diabetes Mellitus

Abstract

Background: Chronic Kidney Disease (Ckd) Encompasses A Spectrum Of Different Pathophysiologic Processes Associated With Abnormal Kidney Function, And A Progressive Decline In Glomerular Filtration Rate (Gfr). The Term Crf Applies To The Process Of Continuing Significant Irreversible Reduction In Nephron Number, And Typically Corresponds To Ckd Stages 3–5 Persistent, Low-Grade Inflammation Likely Participates In The Pathophysiology Of Both Atherosclerosis And Kidney Disease. Although High-Sensitivity C-Reactive Protein (Hscrp) Predicts Future Cardiovascular Risk And Chronic Kidney Disease (Ckd), It Is Unknown Whether Hscrp Levels Predict Adverse Renal Outcomes In Patients With Cardiovascular Disease.


Methods:  We Included All Inpatients With Clinical And / Or Biochemical Evidence Of Chronic Kidney Disease, Admitted In The Hospital For Ckd And Cardiovascular Disease. Patients Who Refused To Give Consent, Critically/Terminally Ill Patients, Patients With Pre-Existing Cardiac Valvular Disease, Hiv Positive Patients, Patients Taking Immune-Suppressive Therapy, Patients On Chemo-Therapy, Acute Kidney Injury Patient Were Excluded. After Taking Institutional Ethical Clearance And Written Consent From The Patients A Cross Sectional Observational Study Was Conducted On Patients Admitted In The Hospital, Who Had Clinical And / Or Biochemical Evidence Of Chronic Kidney Disease. A Detailed Thorough History Was Taken, General Physical Examination, Systemic Examination And Routine And Specific Lab Investigations Were Done To Find Out The Underlying Aetiology, Clinical Features And Outcome Of Chronic Kidney Disease. Pro Forma I -Informed Consent Form Annexure G-Master Chart Proforma.


All The Data Analysis Was Performed Using Ibm Spss Ver. 20 Software. Frequency Distribution And Cross Tabulation Was Used To Prepare The Tables. Quantitative Variables Were Expressed As The Mean And Standard Deviation. Categorical Data Was Expressed As Percentage. Categorical Variables Were Compared By Chi-Square Test. Mean Was Compared Using One Way Anova Analysis. Prism And Microsoft Office Was Used To Prepare The Graphs. Hscrp Tests Measured During Hospitalization/Emergency Room Visits.


Results: This Prospective Observational Study Was Done In 100 Patients In Central India, To Observe Crp Levels In Ckd Patients And To Evaluate Crp As A Marker For Cardiovascular Risk, From 1st December 2019 To 31th October 2020.


In This Study Group Majority Of The Patients Were Above 30 Years Of Age. The Mean Age Of The Study Was 47.8 Years, Male: Female Incidence Was In The Ratio Of 1.85:1. There Was Significant Predominance Of Ckd In Male Patients In The Study. Patterns In The Incidence Of Kidney Disease Across Gender Were Generally Consistent, With Higher Rates Occurring In Men Than In Women. Similarly, Men Were Reported To Have Greater Rates Of Progression Of Nondiabetic Ckd For Some Specific Types Of Kidney Disease, Especially Compared With Premenopausal Women.


In Our Study Sbp And Dbp Were Raised Above The Reference Levels, Mean Sbp Were 148.2±8.81 And Mean Dbp Were 99±6.89. The Mean Level Of Urea Was 146.6±27.5 Mg/Dl. A Significant Correlation Between Serum Creatinine And Crp Levels Were Noted, Which Has Been Shown By Significant P- Value Of <0.0001 And A Significant Negative Correlation Between Crp Levels And Egfr Has Also Been Noted, Which Has Been Shown By Significant P-Value Of <0.0001. There Was An Insignificant Negative Correlation Between Serum Creatinine Levels And Haemoglobin Levels, Which Has Been Shown By Insignificant P-Value Of >0.05 [Mean Level Of Creatinine Was 11.6±2.7 Mg/Dl, Mean Haemoglobin Was 7.469±0.80 Mg/Dl, Hscrp Was Raised Above Reference Level, The Mean Level Hscrp Was 5.45±2.79 Mg/Dl].


The Average Egfr Was 5.45±2.79 Ml/Min/1.73m2. Most Of Patients Were Esrd Patients And Were In Stage 5 Of Ckd, With Most Common Associated Disease Being Htn (49%) Followed By Dm (26%), Whereas Ckd Alone Were 36%. In Most Of The Patients Hscrp Was Raised Above The Baseline. The Mean Levels Of Hscrp Were 5.45±2.79 Mg /Dl. In 85% Of Patients Hscrp Was Raised Above 5 Mg/Dl And In 45 % Of Subjects, Hscrp Was >5 Mg/Dl.


Conclusions: The Present Study Shows Excess Inflammation And Oxidative Stress In The Ckd Patients, As Hscrp Were Raised In 45% Of Patients Above 5 Mg/Dl Which Is Similar To The Previous Studies. Renal Insufficiency Causes A Prolonged Acute Phase Inflammatory Reaction That Is Accompanied With Elevated Inflammatory Markers Such As Hscrp, Il-6. These Inflammatory Markers Are Significantly Associated With Cardiovascular Morbidity And Mortality. Elevated Hscrp Was Associated With Subsequent Risk Of Aki And Progression Of Ckd, Irrespective Of Baseline Kidney Function

Abstract 239 | pdf Downloads 70

References

1. Kasper Dl, Fauci As, Hauser Sl, Longo Dl, Jameson Jl, Loscalzo J. Harrison's Principles Of Internal Medicine 20/E (Vol. 1 & Vol. 2)(Ebook). Mcgraw Hill Professional; 2018 Feb 6.
2. Renal Association. Standards Subcommittee. Treatment Of Adults And Children With Renal Failure: Standards And Audit Measures. Royal College Of Physicians.
3. Gowda Bh, Meera Ks, Mahesh E. Serum Levels Of High Sensitivity C Reactive Protein And Malondialdehyde In Chronic Kidney Disease. International Journal Of Medical Research & Health Sciences. 2015;4(3):608-15.
4. Raju Ds, Lalitha Dl, Kiranmayi P. A Study Of Lipid Profile And Lipid Peroxidation In Chronic Kidney Disease With Special Reference To Hemodialysis. J Clinic Res Bioeth. 2013;4(1):1000143. 71
5. Panichi V, Migliori M, De Pietro S, Taccola D, Bianchi Am, Norpoth M, Metelli Mr, Giovannini L, Tetta C, Palla R. C Reactive Protein In Patients With Chronic Renal Diseases. Renal Failure. 2001 Jan 1;23(3-4):551-62.
6. Qureshi Ar, Alvestrand A, Divino-Filho Jc, Gutierrez A, Heimbürger O, Lindholm B, Bergström J. Inflammation, Malnutrition, And Cardiac Disease As Predictors Of Mortality In Hemodialysis Patients. J Am Soc Nephrol. 2002 Jan;13 Suppl1:S28-36. Pmid: 11792759.
7. Don Br, Kaysen G. Poor Nutritional Status And Inflammation: Serum Albumin: Relationship To Inflammation And Nutrition. Inseminars In Dialysis 2004 Nov (Vol. 17, No. 6, Pp. 432-437). Oxford, Uk: Blackwell Science Inc.
8. Abdulrehman S, Shehzad F, Aziz S, Ali H, Zameer M. Significance Of C-Reactive Protein And Albumin In Chronic Kidney Disease Patients. Biomedica. 2016 Jul;32(3):183.
9. Ridker Pm. C-Reactive Protein: Eighty Years From Discovery To Emergence As A Major Risk Marker For Cardiovascular Disease. Clinical Chemistry. 2009 Feb 1;55(2):209-15. 72
10. Daniels Er. Identifying A Vascoconstrictor Role For Interleukin-6, A Pro-Inflammatory Cytokine (Doctoral Dissertation, Augusta University).
11. Seo Hs. Th Role And Clinical Significance Of High-Sensitivity Creactive Protein In Cardiovascular Disease. Korean Circulation Journal. 2012 Mar 1;42(3):151-3.
12. Iosr Journal Of Pharmacy (E)-Issn: 2250-3013, (P)-Issn: 2319- 4219 Www.Iosrphr.Org Volume 5, Issue 7 (July 2015), Pp. 08-12
13. Wang Ay, Woo J, Lam Cw, Wang M, Sea Mm, Lui Sf, Li Pk, Sanderson J. Is A Single Time Point C-Reactive Protein Predictive Of Outcome In Peritoneal Dialysis Patients? Journal Of The American Society Of Nephrology. 2003 Jul 1;14(7):1871-9.
14. Pandidurai M. A Study On Correlation Of Hs-Crp And Lp (A) In Metabolic Syndrome (Doctoral Dissertation, Tirunelveli Medical College, Tirunelveli).
15. Morrow Da, Rifai N, Antman Em, Weiner Dl, Mccabe Ch, Cannon Cp, Braunwald E. C-Reactive Protein Is A Potent Predictor Of Mortality Independently Of And In Combination With Troponin T In Acute Coronary Syndromes: A Timi 11a Substudy. Journal Of The American College Of Cardiology. 1998 Jun;31(7):1460-5. 73
16. Jialal I, Devaraj S, Venugopal Sk. C-Reactive Protein: Risk Marker Or Mediator In Atherothrombosis? Hypertension. 2004 Jul 1;44(1):6-11. 17.Imig Jd, Ryan Mj. Immune And Inflammatory Role In Renal Disease. Comprehensive Physiology. 2013 Apr;3(2):957. 42.Dai L, Golembiewska E, Lindholm B, Stenvinkel P. End-Stage Renal Disease, Inflammation And Cardiovascular Outcomes. Expanded Hemodialysis. 2017;191:32-43.
17. Adejumo Oa, Okaka Ei, Okwuonu Cg, Iyawe Io, Odujoko Oo. Serum C-Reactive Protein Levels In Pre-Dialysis Chronic Kidney Disease Patients In Southern Nigeria. Ghana Medical Journal. 2016 Apr 7;50(1):31-8.
18. Vardhan A. The Role Of Biochemical Risk Markers, Cytokines And Growth Factors In Atherosclerosis And Adverse Cardiovascular Outcome In Dialysis Patients (Doctoral Dissertation, The University Of Manchester (United Kingdom)).
19. Nand N, Aggarwal Hk, Yadav Rk, Gupta A, Sharma M. Role Of High-Sensitivity C-Reactive Protein As A Marker Of Inflammation In Pre-Dialysis Patients Of Chronic Renal Failure. Jiacm. 2009;10(1):18-22. 74
20. Liakopoulos V, Roumeliotis S, Gorny X, Dounousi E, Mertens Pr. Oxidative Stress In Hemodialysis Patients: A Review Of The Literature. Oxidative Medicine And Cellular Longevity. 2017 Oct;2017.
21. Imro'ati Ta, Thaha M, Irwanadi C. Comparison Of High-Sensitivity C-Reactive Protein Level Between Chronic Kidney Disease Stage. Biomolecular And Health Science. 2018;1(1):1-7. 75
22. Stenvinkel P, Heimbürger O, Paultre F, Diczfalusy U, Wang T, Berglund L, Jogestrand T. Strong Association Between Malnutrition, Inflammation, And Atherosclerosis In Chronic Renal Failure. Kidney International. 1999 May 1;55(5):1899-911.
23. Ikizler Ta, Wingard Rl, Harvell J, Shyr Y, Hakim Rm. Association Of Morbidity With Markers Of Nutrition And Inflammation In Chronic Hemodialysis Patients: A Prospective Study. Kidney International. 1999 May 1;55(5):1945-51. 77
24. Us Renal Data System. Usrds 2009 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.
25. 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.
26. Lindeman Rd, Tobin J, Shock Nw. Longitudinal Studies On The Rate Of Decline In Renal Function With Age. J Am Ger Soc. 1985;33:

Most read articles by the same author(s)