Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Report: Laboratory Investigation Am J Nephrol 2006;26:59–66 DOI: 10.1159/000091806 Positive Acute-Phase Inflammatory Markers in Different Stages of Chronic Kidney Disease João Egidio Romão Jr. Adlei Rogério Haiashi Rosilene Mota Elias Cláudio Luders Rosiani Ferraboli Manoel Carlos Martins Castro Hugo Abensur Nephrology Service, Hospital das Clínicas da FMUSP, and Hospital Beneficência Portuguesa, São Paulo, Brazil hsCRP and  1 -AGP (r = 0.3417; p ! 0.0001). No significant differences were detected between patients with CKD and those undergoing hemodialysis concerning hsCRP (8.2 8 12.1 vs. 6.8 8 7.4 mg/l; p = 0.2980) and  1 -AGP (116.3 8 42.5 vs. 117.2 8 37.9 mg/dl; p = 0.8590). How- ever, the level of hsCRP was significantly reduced in he- modialysis patients compared with patients with stage 5 predialytic disease (12.1 8 13.9 to 6.8 8 7.4 mg/l; p = 0.005). More patients with stage 5 predialytic CKD had an elevated hsCRP serum level compared with pa- tients on hemodialysis (64.7 vs. 37.9%;  2 = 6.230, p ! 0.01). Conclusions: Approximately 50% of patients with CKD – even in the early phase of renal failure – exhibit an activated acute-phase response, which is closely re- lated to the stages of CKD. Hemodialysis may partially correct the inflammatory process present in the immedi- ate predialysis phase of CKD. Copyright © 2006 S. Karger AG, Basel Introduction Cardiovascular disease (CVD) is the major cause of death in patients with chronic kidney disease (CKD). The excess risk of CVD in end-stage kidney disease (ESKD) is due in part to a higher prevalence of established ar- teriosclerotic risk factors, including older age, hyper- Key Words Cardiovascular diseases  Chronic kidney disease  C-reactive protein   1 -Acid glycoprotein Abstract Background: An elevated serum level of acute-phase in- flammatory markers is associated with an increased risk of cardiovascular disease. We hypothesized that elevat- ed acute-phase inflammatory markers are directly asso- ciated with the different stages of chronic kidney disease (CKD). Methods: We evaluated the relationship between serum levels of high-sensitivity C-reactive protein (hsCRP) and  1 -acid glycoprotein (  1 -AGP), as well as the renal function in 224 adult patients with CKD (mean age 56.6 years, 46% male, and 40% diabetics), stratified ac- cording to the glomerular filtration rate (GFR) (based on the National Kidney Foundation/Kidney Dialysis Out- comes Quality Initiatives), and in 94 hemodialysis pa- tients. Results: The mean hsCRP was 8.2 8 12.1 mg/l, and hsCRP levels were 1 5 mg/l in 44.4% of the patients;  1 -AGP levels were 1 125 mg/dl in 33.3% of the patients. Mean hsCRP and  1 -AGP were significantly higher in more severe stages of CKD. A weak inverse relationship was found between GFR and serum hsCRP (r = –0.2205; p = 0.0006) and between GFR and serum  1 -AGP (r = –0.3266; p ! 0.0001). There was a correlation between Received: August 29, 2005 Accepted: November 14, 2005 Published online: February 28, 2006 Nephrolo gy American Journal of João Egidio Romão Junior, MD Nephrology Service, Hospital das Clínicas FMUSP and Hospital Beneficência Portuguesa, Rua Cayowaa, 560 – 51 05018-000 São Paulo, SP (Brazil) Tel. +55 11 3283 5304, Fax +55 11 3672 1753, E-Mail joao.egidio@uol.com.br © 2006 S. Karger AG, Basel 0250–8095/06/0261–0059$23.50/0 Accessible online at: www.karger.com/ajn