Kidney Week

Abstract: FR-PO768

Neutrophils to Lymphocytes Ratio Prior to Death in Hemodialysis Patients: Results from the Global MONDO Initiative

Session Information

• Dialysis: Inflammation and Infection
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Ye, Xiaoling, Renal Research Institute, New York, New York, United States

Xiaoling Ye,

• Yousif, Dalia Elrashid M, Renal Research Institute, New York, New York, United States

Dalia Elrashid M Yousif,

• Raimann, Jochen G., Renal Research Institute, New York, New York, United States

Jochen G. Raimann,

• Wang, Yuedong, University of California - Santa Barbara, Santa Barbara, California, United States

Yuedong Wang,

• Kooman, Jeroen, Maastricht University Medical Centre, Maastricht, Netherlands

Jeroen Kooman,

• van der Sande, Frank, Maastricht University Medical Centre, Maastricht, Netherlands

Frank van der Sande,

• Stuard, Stefano, Fresenius Medical Care, Bad Homburg, Germany

Stefano Stuard,

• Canaud, Bernard J., FMC Deutschland GmbH, Bad Homburg, Germany

Bernard J. Canaud,

• Guinsburg, Adrian M., Fresenius Medical Care, Bad Homburg, Germany

Adrian M. Guinsburg,

• Usvyat, Len A., Fresenius Medical Care North America, Melrose, Massachusetts, United States

Len A. Usvyat,

• Kotanko, Peter, Renal Research Institute, New York, New York, United States

Peter Kotanko,

Group or Team Name

• The MONDO Initiative

Background

Among patients(pts) with end stage renal disease (ESRD), chronic inflammation is highly prevalent and associated with adverse clinical outcomes including CVD and death. Understanding the dynamics of readily available inflammatory markers (NLR,CRP,WBC) across different survival time is an essential way to explore patient- and process-related factors that contribute to adverse outcomes.

Methods

MONDO Initiative is a global retrospective cohort study that contained data of 150k+ pts with in-center HD from 41 countries&6 continents. Adult pts who died within the first 36 months (mos) on HD were stratified into 6 groups, pts died from 0-6, 6-12,12-18,18-24,24-30 and 30-36 mos after HD initiation. Pts who survived 36+ mos were chosen as the control group. Monthly average of NLR, CRP, Neutrophils, Lymphocytes, WBC were obtained, cubic spline function were applied to access the trends and rate of changes for each of the parameters of interest. Additionly, subgroup analysis were performed to explore the sex and regional differences.

Results

18,276 incident HD pts were included, 2,068 died within 6 mos,1,231 died 6 -12 mos,971 died 12 -18 mos,792 died 18-24 mos,721 died 24-30 mos, 648 died 30-36 mos, and 12,295 survived 36+ mos. For pts who with shorter survival time, NLR, Neutrophils, Lymphocytes, WBC&CRP were observed to be higher at HD initiation. Additionaly, all the inflammatory markers were declined after the HD initiation and reached nadir from 3-0 mo, vary by pts' survival time. All the markers with an accrelated trend mos before death. For pts who survived 36+ mos, NLR, CRP and WBC seem to be stable after they reached the nadir. No sex and regional differences were observed.

Conclusion

Understanding the dynamics of readily available inflammatory markers is an important way to explore patient- and process-related factors that contribute to outcomes. NLR variations over survival time may have a prognostic impact.