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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2015  |  Volume : 26  |  Issue : 2  |  Page : 378-379
Sleep quality and C-reactive protein

1 Primary Care Unit, KMT Center, Bangkok, Thailand
2 Visiting Professor, Hainan Medical University, China; Visiting Professor, Faculty of Medicine, University of Nis, Serbia

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Date of Web Publication3-Mar-2015

How to cite this article:
Yasri S, Wiwanitkit V. Sleep quality and C-reactive protein. Saudi J Kidney Dis Transpl 2015;26:378-9

How to cite this URL:
Yasri S, Wiwanitkit V. Sleep quality and C-reactive protein. Saudi J Kidney Dis Transpl [serial online] 2015 [cited 2021 May 18];26:378-9. Available from: https://www.sjkdt.org/text.asp?2015/26/2/378/152546
To the Editor,

The recent report on "Sleep quality and C-reactive protein" is very interesting. [1] Emami Zeydi et al concluded that "there is a correlation between decreased sleep quality in hemodialysis (HD) patients and elevated CRP levels, which may have therapeutic implications. [1] The effect of sleep loss on CRP is well demonstrated by Meier-Ewert et al. [2] Razeghi et al reported that "CRP ≥3.8 μg/mL and advanced age were significantly associated with sleep disorders" [3] in HD patients. Nevertheless, CRP is a non-specific laboratory parameter and there are many factors that can alter its levels. [4] Hence, to interpret the results of CRP in the HD patients, good consideration on many confounding factors is required. [4] This is similar to other laboratory parameters such as IL-10. [5]

Conflict of interest: None declared.

Author's Reply

To the Editor,

We would like to thank Dr. Yasri and Dr. Wiwanitkit for their interest in our recently published article [1] and their thoughtful comments. One of my co-authors and I reply on behalf of the others to the question raised.

As it is known, C-reactive protein (CRP) as an acute-phase protein is a strong predictor of overall mortality and morbidity in hemodialysis (HD) patients. [2] In our study, we found a negative correlation between sleep quality and CRP levels in HD patients. We measured the CRP levels as an inflammatory marker. Although it is a non-specific marker of inflammation, and many other markers are also available for the evaluation of inflammatory state, yet the specific properties of CRP may sufficiently explain its application as compared with other markers in clinical practice. [3] The serum CRP levels convincingly reflect persistent inflammation and/or tissue damage much more accurately than other laboratory parameters of the acute-phase response. [4] Moreover, the CRP values show no diurnal variation and no dependence on age or gender, besides its concentration, which does not alter with the changes in kidney function. Furthermore, its lower cost and availability, particularly in developing countries, is another advantage of the utilization of CRP in clinical practice. Until recently, the available inflammatory markers are not suitable for common clinical practice. CRP is very stable and quite easy to measure. Therefore, the CRP concentration is a very useful non-specific biochemical marker of inflammation. [3],[4]

Aside from the aforementioned reasons about the usefulness of measuring the CRP levels as an appropriate inflammatory marker in clinical practice, we comply with the critics because CRP is a non-specific marker and confounding variables should be considered when interpreting the results. Considering this, patients with a history of infectious disease one month before the study, those on immunosuppressive drugs during the past two months and those having undergone kidney transplant and resumed HD were excluded from our study.

Nevertheless, we suggest a clinical trial to evaluate the effect of anti-inflammatory agents on sleep quality of HD patients to provide a more robust answer to the question that have been raised.

Mr. Amir Emami Zeydi [1] , Mr. Hadi Darvishi Khezri [2]

[1] Department of Nursing, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, and School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, [2] Thalassemia Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran.

E-mail: [email protected]


  1. Emami Zeydi A, Jannati Y, Darvishi Khezri H, et al. Sleep quality and its correlation with serum C-reactive protein level in hemodialysis patients. Saudi J Kidney Dis Transpl 2014; 25:750-5.
  2. Gholipour Baradari A, Emami Zeydi A, Espahbodi F, Shahmohammadi S. Evaluation of Serum C-reactive Protein Level and its Related Factors in Hemodialysis Patients in Sari, Iran. Pak J Biol Sci 2011;14:595-9.
  3. Heidari B. C-reactive protein and other markers of inflammation in hemodialysis patients. Caspian J Intern Med 2013;4:611-6.
  4. Pepys MB, Hirschfield GM. C-reactive protein: A critical update. J Clin Invest 2003;111: 1805-12.

   References Top

Emami Zeydi A, Jannati Y, Darvishi Khezri H, et al. Sleep quality and its correlation with serum c-reactive protein level in hemodialysis patients. Saudi J Kidney Dis Transpl 2014;25: 750-5.  Back to cited text no. 1
Meier-Ewert HK, Ridker PM, Rifai N, et al. Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol 2004;43:678-83.  Back to cited text no. 2
Razeghi E, Sahraian MA, Heidari R, Bagher zadeh M. Association of inflammatory biomarkers with sleep disorders in hemodialysis patients. Acta Neurol Belg 2012;112:45-9.  Back to cited text no. 3
Kanda T. C-reactive protein (CRP) in the cardiovascular system. Rinsho Byori 2001;49: 395-401.  Back to cited text no. 4
Taraz M, Khatami MR, Hajiseyedjavadi M, et al. Association between anti-inflammatory cytokine, IL-10, and sleep quality in patients on maintenance hemodialysis. Hemodial Int 2013;17:382-90.  Back to cited text no. 5

Correspondence Address:
Dr. Sora Yasri
Primary Care Unit, KMT Center, Bangkok, Thailand

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DOI: 10.4103/1319-2442.152546

PMID: 25758897

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