Environmental carbon monoxide level is associated with the level of high-sensitivity c-reactive protein in peritoneal dialysis patients

Inflammation is highly prevalent among peritoneal dialysis (PD) patients. High-sensitivity C-reactive protein (hs-CRP) is the most widely used inflammatory marker in clinical medicine and is correlated with mortality in PD patients. Air pollution is associated with systemic inflammation. The aim of this cross-sectional study was to assess the role of air pollutants and other clinical variables on hs-CRP values in PD patients. We recruited a total of 175 patients who had been undergoing continuous ambulatory PD or automated PD for at least 4 months and regularly followed up. Air pollution levels were recorded by a network of 27 monitoring stations near or in the patients living areas throughout Taiwan. The 12-month average concentrations of particulate matter (PM) with an aerodynamic diameter of <10 and <2.5mm (PM₁₀ and PM_2.5), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), and ozone (O₃) were included. In stepwise linear regression, after adjustment for related factors, white blood cell count (β: 0.27, 95% confidence interval [CI] [0.71, 2.11]) and CO level (β: 0.17, 95% CI [2.5, 21.32]) were positively associated with hs-CRP and serum albumin levels (β:-0.25, 95% CI [-13.69,-3.96]) and normalized protein nitrogen appearance (β:-0.18, 95% CI [-17.7,-2.51]) was negatively associated with hs-CRP. However, serum indoxyl sulfate and p-cresyl sulfate levels were not significantly associated with hs-CRP (P >0.05). In PD patients, the environmental CO level was positively correlated with hs-CRP level.