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Associations of interleukin‐6, C‐reactive protein and serum amyloid A with mortality in haemodialysis patients
Author(s) -
WETMORE JAMES B,
LOVETT DAVID H,
HUNG ADRIANA M,
COOKWIENS GALEN,
MAHNKEN JONATHAN D,
SEN SAUNAK,
JOHANSEN KIRSTEN L
Publication year - 2008
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/j.1440-1797.2008.01021.x
Subject(s) - medicine , serum amyloid a , c reactive protein , serum amyloid a protein , interleukin 6 , amyloid (mycology) , hemodialysis , interleukin , inflammation , pathology , cytokine
SUMMARY: Background: Individuals with end‐stage renal disease (ESRD) manifest a chronic inflammatory state. Serum albumin, C‐reactive protein (CRP), interleukin‐6 (IL‐6) and serum amyloid A (SAA) have been associated with mortality in ESRD, although reports vary as to whether they are true independent markers of mortality. We undertook a prospective study to determine whether these markers could predict mortality in ESRD. Methods: A cohort of individuals on haemodialysis was followed prospectively for a mean of 2.1 years. Albumin, CRP, IL‐6 and SAA were drawn at enrolment. Association between mortality and serum markers was assessed using Cox proportional hazards regression. A trend analysis was undertaken to establish the functional form of the association between serum markers and outcome. Results: After multivariable adjustment, IL‐6 was most strongly associated with mortality, followed closely by albumin ( P = 0.0002 and P = 0.0005, respectively). CRP was marginally associated with mortality ( P = 0.046), and SAA was not independently associated with mortality. In the final model adjusting for the effects of both IL‐6 and albumin simultaneously, both markers remained associated with mortality ( P = 0.003 and P = 0.011). Conclusion: IL‐6 had the strongest independent association with mortality, followed closely by albumin. CRP and SAA were not associated with mortality when measured at single time points. Increasing levels of IL‐6 and decreasing levels of albumin were associated with increased mortality. IL‐6 and albumin may be capturing different aspects of the inflammatory burden observed in haemodialysis patients.