Level of C-reactive protein in chronic hemodialysis patients: a comparative study between patients with non-infected catheters and arteriovenous fistula in a large Saudi hemodialysis center

Abstract

Central venous catheters are associated with infection and resultant higher C-reactive protein levels (CRP), suggesting that catheters may be an important determinant of increased inflammatory response. The increased levels of markers such as CRP are associated with increased risk of premature death and hospitalization in end stage renal disease (ESRD) patients on regular hemodialysis (HD). In this prospective study the mean levels of the inflammatory marker CRP were measured every 2 months over a period of 6 months by using immunoturbidimetric assay in 70 ESRD patients on maintenance HD at Prince Salman Center For Kidney Diseases (PSCKD) who met our inclusion criteria, comparing those dialyzed using a non-infected catheter (35 patients) to those using arteriovenous fistulas (35 patients). Seventy ESRD patients who had been on maintenance HD for more than 6 months were included in the study, with a mean age of 50.09 ± 15.61 years, 80% were males and 20% were females. Serial levels of mean CRP were statistically significantly higher in the group with non-infected catheters (0.83, 0.82, 0.94 mg/dL) compared with those with arteriovenous fistula (0.31, 0.38 and 0.34 mg/dL) with P-values of 0.000, 0.023 and 0.001, respectively. In our study we found no relationship between CRP level and age, sex, hemoglobin albumin, calcium, phosphorus and intact parathyroid hormone level in both groups. Our study shows that catheters might contribute to increased inflammation independent of infection, and support the avoidance of catheters and a timely conversion to fistulas with catheter removal.