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Clin Exp Nephrol. 2015 Aug;19(4):725-31. doi: 10.1007/s10157-014-1048-0. Epub 2014 Nov 8.

A linear relationship between serum high-sensitive C-reactive protein and hemoglobin in hemodialysis patients.

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Department of Internal Medicine, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran,



Inflammatory process in hemodialysis patients involves hematopoiesis. The aim of the study was to determine the relationship between serum C-reactive protein (CRP) as a marker of inflammation with hemoglobin in patients under hemodialysis.


Patients under maintenance hemodialysis for more than 3 months were studied. Serum high-sensitive CRP (hs-CRP) was measured by immunoturbidimetric method and hemoglobin < 11 g/dl was considered as anemia. Iron deficiency anemia was confirmed by percent transferrin saturation < 20 %. Correlation coefficient, linear regression and odds ratio (OR) were used to determine the relationship.


A total of 73 patients aged 50 ± 16.9 years with median hemodialysis duration of 24 (3-280) months entered the study. High serum hs-CRP (> 5 mg/l) was found in 42 (57.5 %) and anemia in 32 (43.8 %) patients. High CRP was significantly associated with anemia OR = 20.8 (95 % CI 5.35-81, p = 0.001). After adjustment for age, dialysis duration, blood indices and serum albumin, the odds of anemia in the high CRP group remained at a significant level of 16.7 (95 % CI 3.7-75, p = 0.001). Hemoglobin levels conversely correlated with serum hs-CRP (r = -0.607, r (2) = 0.36, p = 0.001). In linear regression analysis for each 1 mg/l increase in serum hs-CRP, hemoglobin value increased by 12.4 % (p = 0.002). Serum iron at cutoff level of 54 µg/dl discriminated patients with and without iron deficiency anemia with sensitivity of 93.3 %, specificity of 84 % and accuracy of 90 % (AUC ± SE = 0.901 ± 0.04 (95 % CI, 0.805-0.998, p = 0.001).


These findings indicate that in hemodialysis patients, the inflammatory process alters hemoglobin level in converse correlation with CRP concentration with a linear relationship pattern. Serum iron <54 µg/dl indicates iron deficiency anemia with high accuracy.

[Indexed for MEDLINE]

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