The Relationship of High-Sensitivity C-Reactive Protein (Hs-CRP) Serum Level and Peritonitis in Patients on Peritoneal Dialysis

Document Type : Original Article (s)


1 Associate Professor, Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 General Practitioner, Shahrekord Health Center, Shahrekord University of Medical Sciences, Shahrekord, Iran

4 Nurse, Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

5 Assistant Professor, Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran


Background: C-reactive protein (CRP) is a predictor of cardiovascular diseases in both normal people and patients on hemodialysis .This study aimed to assess the relationship of high-sensitivity C-reactive protein (Hs-CRP) serum level and peritonitis in patients on peritoneal dialysis.Methods: 113 patients on peritoneal dialysis in Isfahan city, Iran, participated in our study in 2015. Serum albumin and Hs-CRP levels were measured in each patient at three times (baseline, and 6 and 12 month after that) and the patients were followed up for 1 year. All the patients were evaluated for peritonitis in every visit. At the end of the study, two groups of patients on peritoneal dialysis with and without peritonitis were compared.Findings: Among 113 patients, 24 were excluded from the study because of death or kidney transplantation and 89 patients were included in final analysis. The mean Hs-CRP levels in patients with peritonitis were 4.83, 5.79, and 7.42 mg/l at baseline, and 6 and 12 month after it, respectively; these levels were 4.47, 3.19, and 2.69 mg/l in patients without peritonitis, respectively. In addition, the mean albumin levels in patient with peritonitis were 3.38, 3.29 and 3.40 mg/l at baseline, and 6 and 12 month after it, respectively; these values were 3.56, 4.05, and 3.51 mg/l in patients without peritonitis, respectively.Conclusion: Results showed that with increase in Hs-CRP level, the risk of peritonitis increased. Besides, the albumin level decreased among patients with peritonitis in comparison with patients without peritonitis; there was no significant correlation between albumin level and peritonitis.


  1. 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 1997; 336(14): 973-9.
  2. Yeun JY, Kaysen GA. Acute phase proteins and peritoneal dialysate albumin loss are the main determinants of serum albumin in peritoneal dialysis patients. Am J Kidney Dis 1997; 30(6): 923-7.
  3. Noh H, Lee SW, Kang SW, Shin SK, Choi KH, Lee HY, et al. Serum C-reactive protein: a predictor of mortality in continuous ambulatory peritoneal dialysis patients. Perit Dial Int 1998; 18(4): 387-94.
  4. Fernandez–Reyes MJ, Hevia C, Bajo MA, Peso GD, Costero O, Diez JJ, et al. A Comparative Study of C-Reactive Protein Plasma Levels in Patients on Hemodialysis and Peritoneal Dialysis. Hemodialysis International 2001; 5(1): 55-8.
  5. Gould IM, Casewell MW. The laboratory diagnosis of peritonitis during continuous ambulatory peritoneal dialysis. Journal of Hospital Infection 1986; 7(2): 155-60.
  6. Li PK, Szeto CC, Piraino B, Bernardini J, Figueiredo AE, Gupta A, et al. Peritoneal dialysis-related infections recommendations: 2010 update. Perit Dial Int 2010; 30(4): 393-423.
  7. Fried LF, Bernardini J, Johnston JR, Piraino B. Peritonitis influences mortality in peritoneal dialysis patients. J Am Soc Nephrol 1996; 7(10): 2176-82.
  8. Mujais S. Microbiology and outcomes of peritonitis in North America. Kidney Int Suppl 2006; (103): S55-62.
  9. Kendrick J, Teitelbaum I. Strategies for improving long-term survival in peritoneal dialysis patients. Clin J Am Soc Nephrol 2010; 5(6): 1123-31.
  10. Liu SH, Li YJ, Wu HH, Lee CC, Lin CY, Weng CH, et al. High-sensitivity C-reactive protein predicts mortality and technique failure in peritoneal dialysis patients. PLoS One 2014; 9(3): e93063.
  11. Lacson E Jr, Levin NW. C-reactive protein and end-stage renal disease. Semin Dial 2004; 17(6): 438-48.
  12. Owen WF, Lowrie EG. C-reactive protein as an outcome predictor for maintenance hemodialysis patients. Kidney Int 1998; 54(2): 627-36.
  13. Schindler R, Boenisch O, Fischer C, Frei U. Effect of the hemodialysis membrane on the inflammatory reaction in vivo. Clin Nephrol 2000; 53(6): 452-9.
  14. Yeun JY, Levine RA, Mantadilok V, Kaysen GA. C-Reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis 2000; 35(3): 469-76.
  15. Wanner C, Zimmermann J, Schwedler S, Metzger T. Inflammation and cardiovascular risk in dialysis patients. Kidney Int 2002; 61(Suppl 80): S99–S102.
  16. Galle J. Oxidative stress in chronic renal failure. Nephrol Dial Transplant 2001; 16(11): 2135-7.
  17. Herzig KA, Purdie DM, Chang W, Brown AM, Hawley CM, Campbell SB, et al. Is C-reactive protein a useful predictor of outcome in peritoneal dialysis patients? J Am Soc Nephrol 2001; 12(4): 814-21.
  18. Avram MM, Fein PA, Paluch MM, Schloth T, Chattopadhyay J. Association between C-reactive protein and clinical outcomes in peritoneal dialysis patients. Adv Perit Dial 2005; 21: 154-8.
  19. Ramanathan K, Padmanabhan G, Vijayaraghavan B. Evaluation of continuous ambulatory peritoneal dialysis fluid C-reactive protein in patients with peritonitis. Saudi J Kidney Dis Transpl 2016; 27(3): 467-72.
  20. Danielski M, Ikizler TA, McMonagle E, Kane JC, Pupim L, Morrow J, et al. Linkage of hypoalbuminemia, inflammation, and oxidative stress in patients receiving maintenance hemodialysis therapy. Am J Kidney Dis 2003; 42(2): 286-94.
  21. Kim SB, Yang WS, Min WK, Lee SK, Park JS. Reduced oxidative stress in hypoalbuminemic CAPD patients. Perit Dial Int 2000; 20(3): 290-4.
  22. Su YJ, Liao SC, Cheng BC, Hwang JC, Chen JB. Increasing high-sensitive C-reactive protein level predicts peritonitis risk in chronic peritoneal dialysis patients. BMC Nephrol 2013; 14: 185.
  23. Lam MF, Leung JC, Lo WK, Tam S, Chong MC, Lui SL, et al. Hyperleptinaemia and chronic inflammation after peritonitis predicts poor nutritional status and mortality in patients on peritoneal dialysis. Nephrol Dial Transplant 2007; 22(5): 1445-50.