Association Between C-Reactive Protein and Biomarkers of Bone and Mineral Metabolism in Chronic Hemodialysis Patients: A Cross-Sectional Study

Objective

Both chronic inflammation and dysregulation of bone and mineral metabolism are closely related with long-term outcomes of dialysis patients. Our objective was to investigate the relationship between these two abnormalities.

Design

This was a cross-sectional study.

Setting

This study was performed at a hospital-based hemodialysis center.

Patients

We enrolled 448 (male, 198; female, 250) clinically stable hemodialysis patients. Patients with chronic inflammatory disease, malignancy, or viral hepatitis were excluded. Their age (mean ± SD) was 57.4 ± 12.5 years.

Main Outcome Measures

Biomarkers, including high-sensitivity C-reactive protein (hsCRP), total calcium, phosphate, and intact parathyroid hormone levels, were measured and compared with the recommended range in the K/DOQI guidelines. Correlations between these parameters were analyzed, and factors independently associated with hsCRP and the calcium phosphate product (Ca × P) were identified by regression analysis.

Results

Most patients did not achieve the K/DOQI recommended therapeutic range in the four parameters, and only 50 patients (11%) met their treatment goals. The hsCRP level was directly related to calcium, phosphate, and Ca × P. Patients who achieved the guidelines’ range had lower hsCRP levels (1.97 mg/L vs. 2.71 mg/L, P < .05). A high hsCRP level (≧ 10 mg/L) was associated with higher calcium, phosphate, and Ca × P levels, and lower albumin levels. Serum albumin, Ca × P, alkaline phosphatase, and diabetes independently predicted hsCRP levels.

Conclusion

There is a strong association between chronic inflammation and the disturbance of bone mineral metabolism in chronic hemodialysis patients.