Kidney Week

Abstract: FR-PO828

Low Eosinophil Count and Decrease in Eosinophil Count During the First 6 Months After Hemodialysis (HD) Are Associated with High Mortality

Session Information

• Dialysis: Hospitalization and Mortality
  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

• Kang, Duk-Hee, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Duk-Hee Kang,

• Lee, Yong kyu, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Yong kyu Lee,

• Kleine, Carola-Ellen, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Carola-Ellen Kleine,

• Rhee, Connie, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Connie Rhee,

• Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

• Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Elani Streja,

• Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Kamyar Kalantar-Zadeh,

Background

Eosinophilia has been recognized to occur in HD patients, however its causes and clinical significance are still uncertain. Eosinophils are traditionally known as the moderator of allergic reactions, however they have now emerged as one of the most important immune-regulating cells, and an increase in eosinophil count is also reported to be a predictor of vascular disease in the general population. Associations of eosinophil count (EOS) and its changes with mortality in dialysis patients are still unknown.

Methods

In a cohort of 107,056 incident HD patients treated by a large dialysis organization during 2007-2011, we examined the relationships of baseline EOS (Q1-average within 3 months of HD transition) and 6-month changes in EOS (Q2-Q1) with mortality using Cox proportional hazards models. Three adjustment models were used including case-mix variables and markers for malnutrition and inflammation.

Results

Baseline EOS and fraction during Q1 were 231 (interquartile range: 155-339) /mm³ and 3.2% (2.2-4.6). Eosinophilia (>350/mm³) was observed in 23.4% of patients. There was a gradual increase in mean EOS after the initiation of dialysis. The 6-month mean and percent changes in EOS were 5.1 (-53 to 199) /mm³/quarter and 0.11 (-0.22 to 0.28) %/quarter, which did not parallel with the changes in WBC count. In fully adjusted models, mortality risk was highest in subjects with lower baseline EOS (<150/mm³), and also slightly higher in patients with higher levels (>550/mm³) resulting in a reverse J-shaped relationship. Compared to the group with stable EOS (change: -50 to <50/mm³/quarter), both decrease or increase in EOS was associated with higher all-cause mortality risk. Case-mix-adjusted HR [95% CI] 2.05 [1.93-2.18] in the decrease group and 1.25 [1.19-1.32] in the increase group, respectively. [Figure]

Conclusion

Low baseline EOS and a 6-month EOS decrease following dialysis initiation were associated with higher all cause mortality risk.

Funding

• NIDDK Support