Association between C-reactive protein and mortality in peritoneal dialysis patients: a meta-analysis

Objective: The aim of this study was to evaluate the association between C-reactive protein (CRP) levels and all-cause mortality and cardiovascular disease mortality in patients undergoing peritoneal dialysis (PD). Methods: A systematic literature search up to March 2016 was performed in PubMed, Web of Science and the Cochrane Library. Hazard ratio (HR) with 95% confidence interval (CI) for all-cause mortality and cardiovascular disease mortality was extracted from each study. The pooled analysis was performed using the random-effect model by Rev Man 5.3 software. Results: Eighteen studies on CRP involving a total of 3869 PD patients were included in this meta-analysis. The combined analysis revealed that CRP levels were significantly positively associated with all-cause mortality (HR 1.04, 95% confidence interval: 1.02-1.06, P=0.0003) and cardiovascular disease mortality (HR 2.54, 95% confidence interval: 1.08-5.94, P=0.03) in peritoneal dialysis patients. Furthermore, statistically significant heterogeneity was found. The results for subgroup analysis of geographic region, study type, sample size and CRP type were consistent with the result about CRP levels and all-cause mortality. Conclusions: Elevated level of CRP was significantly associated with higher risks of all-cause and cardiovascular disease mortality in PD patients. Early detection of CRP levels in peritoneal dialysis patients is likely to identify patients at increased risk of mortality.