C-reactive protein to albumin ratio predicts future volume overload in peritoneal dialysis patients: a retrospective cohort study

AIMS: To evaluate the predictive value of the C-reactive protein to albumin ratio (CAR) for 6-month volume overload in peritoneal dialysis (PD) patients. METHODS: Retrospective cohort study of 167 stable PD patients without baseline volume overload. CAR was measured at enrollment; volume status was reassessed via bioelectrical impedance analysis (BIA) at 6 months. Multivariate logistic regression, ROC, and restricted cubic spline (RCS) analyses were used. RESULTS: < 0.001). Multivariate analysis identified diabetes (OR = 11.85) and baseline CAR (OR = 9.72) as independent predictors. The AUC for CAR predicting volume overload was 0.73, which is superior to that of CRP or albumin alone. An optimal CAR cutoff of 1.09 yielded 73.2% sensitivity and 60.7% specificity. RCS analysis indicated a linear dose-response relationship between CAR and volume overload risk (P for non-linearity = 0.501). CONCLUSION: Baseline CAR is a simple, low-cost biomarker for predicting 6-month volume overload in PD patients, valuable for risk stratification in resource-limited settings.