Malnutrition and inflammation in peritoneal dialysis patients

Background. Malnutrition, cardiovascular disease, and heightened inflammation are highly prevalent in dialysis patients, and major contributors to morbidity and mortality. We have investigated the inter-relationship between malnutrition and inflammation, and their impact on morbidity and mortality in peritoneal dialysis (PD) patients. Method. We enrolled 63 PD patients beginning in November 2000, and measured C-reactive protein (CRP) and various nutritional markers, including prealbumin. Results. CRP level was elevated in 29% of the PD patients. Diabetics had higher CRP than non-diabetics (24 vs. 9.3 mg/L, P=0.016). Patients who were hospitalized during the study had higher enrollment CRP (16 vs. 12.5 mg/L, P=0.05) and lower enrollment albumin (3.5 vs. 3.9 g/dL, P=0.002), blood urea nitrogen (BUN) (40 vs. 49 mg/dL, P=0.034), and protein catabolic rate (nPCR) (0.88 vs. 1.0 g/kg/day, P=0.02) than those who were not hospitalized. Enrollment level of CRP was inversely correlated with nutritional markers prealbumin (r=-0.5, P<0.0001) and creatinine (r=-0.35, P<0.01). After adjusting for age, race, gender, diabetes, and CRP level, prealbumin continued to correlate with other nutritional markers. There was a trend toward association of elevated CRP with all-cause mortality in PD patients. Conclusion. It is useful to incorporate prealbumin and CRP in the regular assessment of PD patients, whose survival may be improved by better management of malnutrition and inflammation.