C-REACTIVE PROTEIN, A POSSIBLE VALUABLE PREDICTIVE INFLAMMATORY MARKER IN HCV POSITIVE HEMODIALYSIS PATIENTS

Abstract

Recurrent or chronic Inflammatory processes are common in individuals with chronic renl disease (CKD), including those with chronic renal failure (CRF) and especially end-stage renal disease (ESRD). This is due to many underlying factors, including the uremic milieu, elevated levels of circulating proinflammatory cytokines, oxidative stress, carbonyl stress, protein-energy wasting, enhanced incidence of infections (especially dialysis-access related) and others. Although the definition of inflammation is unclear in this setting, CRF-associated chronic inflammation, as assessed by increased C-reactive protein (CRP) levels above 5 mg/L over at least three months, has been reported in 30 to 60 percent of North American and European dialysis patients, with dialysis patients in Asian countries possibly having a lower prevalence. The acute phase response is a major pathophysiologic phenomenon that accompanies inflammation. With this reaction, normal homeostatic mechanisms are replaced by new set points that presumably contribute to defensive or adaptive capabilities. Acute phase proteins are defined as those proteins whose plasma concentrations increase (positive acute phase proteins), such as C-reactive protein (CRP), or decrease (negative acute phase proteins) such as albumin, during inflammatory states. Measurement of the levels of these proteins is frequently utilized to define the presence and/or degree of inflammation in a given patient. A number of inflammatory markers have been studied in patients with CKD. Despite its name, the "acute" phase response can persist over months to years and become chronic. In such states of chronic inflammation, positive acute phase proteins including CRP (normal range <1 mg/L) may be slightly but persistently increased, which can predispose to an increased risk of atherosclerotic cardiovascular disease (CRP 1 to 3 mg/L). However, in many CKD patients, especially in maintenance dialysis patients, serum CRP levels are persistently between 5 and 50 mg/L, although they may fluctuate widely. The study here included 100 subjects classified into 3 groups; the first group included 40 ESRD patients on maintenance hemodialysis with HCV positive antibody, the second group included 40 ESRD patients on maintenance hemodialysis with HCV negative antibody and the third group included 20 healthy subjects as a control group. The aim of this work is to study the response of HCV positive hemodialysis patients and its impact on CRP level as a surrogate marker of inflammation. The patients were chosen on the basis of being on maintenance hemodialysis for at least one year and we excluded patients with acute or chronic infectious diseases, with multi-systemic diseases, with malignancy, using AV graft or temporary catheter or infected AVF and Previous renal transplant recipients. The patients were subjected to careful history taking including age, sex, etiology of CKD, duration of dialysis of patients, viral status and all possible forms and causes of infection plus thorough clinical examination including body weight, BMI, blood pressure, pulse and temperature. Both patients and normal subjects were subjected to laboratory investigations that included complete blood cell count with differential cell count, serum urea, creatinine, albumin and electrolytes, lipid profile, ESR level, C-reactive protein level (with a cutoff value of 6 mg/L), HCV Ab by ELISA and iron profile. In the study we found a significant difference in serum albumin level between the control group and the dialysis groups as it was much higher in the control group which confirms the fact of malnutrition in ESRD patients. Also the present study showed a significant difference between the studied groups concerning Hb level as the mean level in the control group was higher than both dialysis groups. The study also showed that serum CRP level was much higher in the dialysis groups than the control group denoting the condition of chronic inflammation in ESRD patients.