title: Patterns and prognostic value of total and differential leukocyte count in chronic kidney disease.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the levels and patterns of total and differential leukocyte counts and their prognostic importance in a cohort of people with and without chronic kidney disease (CKD).
  
  
  METHODS
  Among 153 veterans without CKD and 267 with, blood leukocyte count was measured at baseline and then repeatedly over a decade. The patterns of change in leukocyte count between the two groups were compared. In the CKD cohort, the spikes in leukocyte counts were compared to the combined endpoint of ESRD and death.
  
  
  RESULTS
  Patients with CKD had more granulocytes and eosinophils and fewer lymphocytes. Over time, granulocytes increased and lymphocytes decreased in those with and without CKD. In addition, in those with CKD, over time eosinophils fell and monocytes increased. Compared with their non-CKD counterparts, patients with CKD had between 1.5- and 3.0-fold more spikes in leukocyte counts. Independent risk factors for the combined endpoint were associated with spikes in the leukocyte counts of absolute and percent eosinophil count, percent granulocyte, and percent monocyte counts. In a multivariate adjusted joint model, both granulocyte and monocyte spikes were independently associated with ESRD and death (hazard ratio 1.67 and 1.52 respectively, P < 0.05).
  
  
  CONCLUSIONS
  Compared with those without CKD, patients with CKD have more eosinophils and granulocytes and fewer lymphocytes. Greater variation in leukocytes is seen. Spikes in granulocyte and monocyte percentages among patients with CKD are of independent prognostic importance.
authors.affiliation: Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN 46202, USA. ragarwal@iupui.edu
authors.forename: Rajiv
authors.initials: R
authors.lastname: Agarwal
authors.forename: Robert P
authors.initials: RP
authors.lastname: Light
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002908:Chronic Disease; D018450:Disease Progression; D004804:Eosinophils / Q000276:immunology*; D005260:Female; D006098:Granulocytes / Q000276:immunology*; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D007249:Inflammation / Q000097:blood / Q000276:immunology* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000097:blood / Q000276:immunology* / Q000401:mortality; D007676:Kidney Failure, Chronic / Q000097:blood / Q000276:immunology* / Q000401:mortality; D007958:Leukocyte Count; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014728:Veterans