White blood cells as a novel mortality predictor in haemodialysis patients.
BACKGROUND
Many conventional cardiovascular risk factors in the general population are not as predictive in end-stage renal disease (ESRD). As absolute neutrophil count and total white blood cell (WBC) count are associated with adverse cardiovascular outcomes and all-cause mortality, this analysis was undertaken to explore the associations of WBC variables with mortality risk in ESRD.


METHODS
Of a total study population of 44 114 ESRD patients receiving haemodialysis during 1998 at facilities operated by Fresenius Medical Care, North America, 25 661 patients who underwent differential white cell count and had complete follow-up were included. Information on case mix (age, gender, race), clinical (diabetes, body mass index), and laboratory variables (haematocrit, albumin, creatinine, potassium, calcium, phosphorus, bicarbonate, ferritin, transferrin saturation and differential WBC count) was obtained. Associations between lymphocyte count, neutrophil count and demographic and clinical variables were examined using linear regression. Associations between WBC variables and survival were estimated using Cox proportional hazard regression.


RESULTS
A higher lymphocyte count was associated with higher serum albumin and creatinine, lower age and black race. High neutrophil count was associated with lower serum albumin and creatinine, younger age and white race (all Ps <0.0001). Cox proportional hazard regression showed an increased lymphocyte count was associated with reduced mortality risk [HR 0.86 (0.83-0.89) per 500/ml increase in lymphocyte count] and an increased neutrophil count was associated with increased mortality risk [HR 1.08 (1.06-1.09) per 1000/ml increase in neutrophil count].


CONCLUSIONS
An increased neutrophil count is strongly associated with, and reduced lymphocyte count associated less strongly with, many surrogates of both malnutrition and inflammation. An increased neutrophil count and reduced lymphocyte count are independent predictors of increased mortality risk in haemodialysis patients.
Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC, USA. redda001@mc.duke.edu
Donal N
DN
Reddan
Preston S
PS
Klassen
Lynda A
LA
Szczech
Joseph A
JA
Coladonato
Susan
S
O'Shea
William F
WF
Owen
Edmund G
EG
Lowrie
D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000276:immunology / Q000401:mortality; D005260:Female; D005293:Ferritins / Q000378:metabolism; D006801:Humans; D007676:Kidney Failure, Chronic / Q000276:immunology* / Q000401:mortality*; D007958:Leukocyte Count; D016014:Linear Models; D008214:Lymphocytes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism*; D006435:Renal Dialysis; D012307:Risk Factors
D005293:Ferritins