title: Bone marrow pathology predicts mortality in chronic hemodialysis patients.
abstract: BACKGROUND
  A bone marrow biopsy is a useful procedure for the diagnosis and staging of various hematologic and systemic diseases. The objective of this study was to investigate whether the findings of bone marrow studies can predict mortality in chronic hemodialysis patients.
  
  
  METHODS
  Seventy-eight end-stage renal disease patients on maintenance hemodialysis underwent bone marrow biopsies between 2000 and 2011, with the most common indication being unexplained anemia followed by unexplained leukocytosis and leukopenia.
  
  
  RESULTS
  The survivors had a higher incidence of abnormal megakaryocyte distribution (P = 0.001), band and segmented cells (P = 0.021), and lymphoid cells (P = 0.029) than the nonsurvivors. The overall mortality rate was 38.5% (30/78), and the most common cause of mortality was sepsis (83.3%) followed by respiratory failure (10%). In multivariate Cox regression analysis, both decreased (OR 3.714, 95% CI 1.671-8.253, P = 0.001) and absent (OR 9.751, 95% CI 2.030-45.115, P = 0.004) megakaryocyte distribution (normal megakaryocyte distribution as the reference group), as well as myeloid/erythroid ratio (OR 1.054, CI 1.012-1.098, P = 0.011), were predictive of mortality.
  
  
  CONCLUSIONS
  The results of a bone marrow biopsy can be used to assess the pathology, and, in addition, myeloid/erythroid ratio and abnormal megakaryocyte distribution can predict mortality in chronic hemodialysis patients.
authors: Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou 333, Taiwan ; College of Medicine, Chang Gung University, Taoyuan 333, Taiwan ; Kidney Research Center, Chang Gung Memorial Hospital, Linkou 333, Taiwan.
authors: Cheng-Hao
authors: CH
authors: Weng
authors: Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou 333, Taiwan ; College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
authors: Kuan-Ying
authors: KY
authors: Lu
authors: College of Medicine, Chang Gung University, Taoyuan 333, Taiwan ; Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital, Keelung 204, Taiwan.
authors: Ching-Chih
authors: CC
authors: Hu
authors: Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou 333, Taiwan ; College of Medicine, Chang Gung University, Taoyuan 333, Taiwan ; Kidney Research Center, Chang Gung Memorial Hospital, Linkou 333, Taiwan.
authors: Wen-Hung
authors: WH
authors: Huang
authors: Department of Nephrology, China Medical University Hospital, Taichung 404, Taiwan ; College of Medicine, China Medical University, Taichung 404, Taiwan.
authors: I-Kwan
authors: IK
authors: Wang
authors: Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou 333, Taiwan ; College of Medicine, Chang Gung University, Taoyuan 333, Taiwan ; Kidney Research Center, Chang Gung Memorial Hospital, Linkou 333, Taiwan ; Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou 333, Taiwan.
authors: Tzung-Hai
authors: TH
authors: Yen
mesh_terms: D000368:Aged; D001853:Bone Marrow / Q000473:pathology*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000473:pathology*; D007964:Leukocytosis / Q000473:pathology; D007970:Leukopenia / Q000473:pathology; D008297:Male; D008533:Megakaryocytes / Q000473:pathology; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies