C-reactive protein-to-albumin ratio and six-month mortality in incident hemodialysis patients. Issue 1 (31st December 2023)

• Record Type: Journal Article
• Authors: Sant'Ana, Mariana; Gameiro, Joana; Costa, Cláudia; Branco, Carolina; Marques da Silva, Bernardo; Peres, Nadiesda; Cardoso, Ana; Abrantes, Ana Mafalda; Fonseca, José Agapito; Outerelo, Cristina; Resina, Cristina; Lopes, José António
• Is Part Of: Renal failure. Volume 45:Issue 1(2023)
• Publication Date: 2023-12-31
• Subjects: Hemodialysis -- mortality -- inflammation -- malnutrition; Chronic renal failure -- Periodicals; Acute renal failure -- Periodicals; Uremia -- Periodicals; 616.614005
• DOI: 10.1080/0886022X.2023.2182615
• Languages: English
• ISSNs: 0886-022X

Abstract

Abstract: Background: The first few months of hemodialysis (HD) are associated with a higher risk of mortality. Protein-energy malnutrition is a demonstrated major risk factor for mortality in this population. The C-Reactive Protein to Albumin ratio (CAR) has also been associated with increased mortality risk. The aim of this study was to determine the predictive value of CAR for six-month mortality in incident HD patients. Methods: Retrospective analysis of incident HD patients between January 2014 and December 2019. CAR was calculated at the start of HD. We analyzed six-month mortality. A Cox regression was performed to predict six-month mortality and the discriminatory ability of CAR was determined using the receiver operating characteristic (ROC) curve. Results: A total of 787 patients were analyzed (mean age 68.34 ± 15.5 years and 60.6% male). The 6-month mortality was 13.8% ( n = 109). Patients who died were significantly older ( p < 0.001), had more cardiovascular disease ( p = 0.010), had central venous catheter at the start of HD ( p < 0.001), lower parathyroid hormone (PTH) level ( p = 0.014) and higher CAR ( p = 0.015). The AUC for mortality prediction was 0.706 (95% CI (0.65–0.76), p < 0.001). The optimal CAR cutoff was ≥ 0.5, HR 5.36 (95% CI 3.21–8.96, p < 0.001). Conclusion: We demonstrated that higher CAR was significantly associated with a higher mortality risk in the first six months of HD, highlighting the prognostic importance of malnutrition and inflammation in patients starting chronic HD.