C-reactive protein (CRP) and risk factors of atherosclerosis in chronic hemodialysis patients Kenji Yuasa, Hiroaki Sugiyama, Tetsuo Kouzi, Kazuhiro Ma

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1 C-reactive protein (CRP) and risk factors of atherosclerosis in chronic hemodialysis patients Kenji Yuasa, Hiroaki Sugiyama, Tetsuo Kouzi, Kazuhiro Matsushita, Kazumichi Oota, Shuusaku Mas uda, Hiroi Sawamura, Nobuaki Miyamoto, Naotami Terao Kidney Center, Kochi-Takasu Hospital In hemodialysis (HD) patients, elevated serum C-reactive protein (CRP) levels have significant associations with hypoalbuminemia, malnutrition, morbidity and mortality, and suggested to predictive markers of atherosclerosis. In this study, we assessed clinical significance of CRP especially the relationship between the serum CRP level and risk factors of atherosclerosis in HD outpatients without diabetes mellitus. We measured serum CRP levels and other parameters in 233 HD patients without acute infection in June Patients were divided into two groups based on serum CRP levels (high CRP group: CRP 0.3mg/dL, and low CRP group CRP<0.3mg/dL). White blood cell (WBC) and numbers f drugs prescribed for angina pectoris were signifi cantly greater in high CRP group than in the low CRP group. As risk factors for atherosclerosis, obesity (BMI 26.4), low dose dialysis (KT/V for urea<1.0), and low protein intake (PCR<0.9g/kg/day) showed a signifi cantly greater frequency in the high CRP group than in the low CRP group. In multiple regression analysis, obesity and low dose dialysis were risk factors of elevated CRP level. In conclusion, elevated CRP level may be associated with ishemic heart disease, obesity, and low dose dialysis.

4 Hypertension: SBP 140mmHg and/or DBP 90mmHg, Hypercholesterolemia: TC 180mg/dL, Low HDL-cholester olemia: HDL-C<40mg/dL, High LDL-cholesterolemia: LDL-C 100mg/dL, Smoker: over 10 cigarettes, Obesity: BMI 26.4, Aging: M 45yrs, F 56yrs, Low dose dialysis: KT/V<1.0, Low protein intake: PCR<0.9, Anemia: Ht<30%, Hypoalbuminemia: Alb<3.5g/dL, Large weight gain: ƒ BW/DW 5%, Long duration of dialysis: over 15 years, Secon dary hyperparathyroidism: i-pth 720pg/mL, High level of serum phosphate: P 6.5mg/dL (Significan ce: chi-square test)

5 1) Bergstrom J, Lindholm B: Malnutrition, cardiac disease, and mortality: An integrated point of view. Am J Kidney Dis 32: , ) Lowrie EG: Acute-phase inflammatory process contributes to malnutrition, anemia, and possibly other abnormalities in dialysis patients. Am J Kid ney Dis 32 (Suppl 4): S105-S112, 1998

6 3) Zimmermann J, Herringer S, Pruy A, Metzger T, Wanner C: Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Kidney Int 55: , ) Iseki K, Tozawa M, Yoshi S, Fukiyama K: Serum C-reactive protein (CRP) and risk of death in chronic dialysis patients. Nephrol Dial Transplant 14: , ) Kario K, Matsuo T, Kobayashi H, Matsuo M, Asada R, Koide M: High lipoprotein (a) levels in chronic hemodialysis patients are closely related to the acute phase reaction. Thromb Haemost , ) Stenvinkel P, Heimburger O, Tuck CH, Berglund L: Apo (a)-isoform size, nutritional status and inflammatory markers in chronic renal failure. Kidney Int 53: , ) Arici M, Walls J: End-stage renal disease, atheros clerosis, and cardiovascular mortality: Is C-reac tive protein the missing link?. Kidney Int 59: , ) Stenvinkel P, Heimburger O, Paultre F, Diczfalusy U, Wang T, Berglund L, Jogestrand T: Strong association between malnutrition, inflammation, and atherosclerosis in renal failure. Kidney Int 55: , ) Panichi V, Migliori M, De Pietro S, Metelli MR, Taccola D, Perez R, Palla R, Rindi P, Cristofani R, Tetta C: Plasma C-reactive protein in hemodialys is patients: A cross-sectional, longitudinal clinical survey. Blood Purif 18: 30-36, ) Ridker PM, Cushman M, Stampfer MJ, Tracy RP, : - Hennekens CH: Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med 336: , ) Riella MC: Malnutrition in dialysis: Malnourish ment or uremic inflammatory response?. Kidney Int 57: , ) Festa A, D'Agostino R Jr, Williams K, Karter AJ, Mayer-Davis EJ, Tracy RP, Haffner SM: The relation of body fat mass and distribution to markers of chronic inflammation. Int J Obes Relat Metab Disord 25: , ) Weyer C, Yudkin JS, Stehouwer CD, Schalkwijk CG, Pratley RE, Tataranni PA: Humoral markers of inflammation and endothelial dysfunction in rela tion to adiposity and in vivo insulin action in Pima Indians. Atherosclerosis 161: , ) Brook RD, Bard RL, Rubenfire M, Ridker PM, Rajagopalan S: Usefulness of visceral obesity (waist/hip ratio) in predicting vascular endothelial function in healthy overweight adults. Am J Cardiol 88: , ) Tchernof A, Nolan A, Sites CK, Ades PA, Poehlman ET: Weight loss reduces C-reactive protein levels in obese postmenopausal women. Circulation 105: E , ) Bach-Ngohou K, Nazih H, Nazia-Sanderson F, Zair Y, Le Career D, Krempf M, Bard JM: Nega tive and independent influence of apolipoprotein E on C-reactive protein (CRP) concentration in obeses adults. Potential anti-inflammatory role of apoe in vivo. Int J Obes Relat Metab Disord 25: , 2001

Efficacy of Colestimide as a phosphate binder in patients on chronic hemodialysis Toshiyuki Date, Yoshiteru Kawashita, Nobuyoshi Satake Jin-ai-kai Dat

Efficacy of Colestimide as a phosphate binder in patients on chronic hemodialysis Toshiyuki Date, Yoshiteru Kawashita, Nobuyoshi Satake Jin-ai-kai Date Clinic In some patients on chronic hemodialysis,