Kidney Week

Abstract: FR-PO816

Association of White Blood Cell Count with Survival in Incident Hemodialysis Patients

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

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

Tiffany Zai,

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

Christina Park,

• Hsiung, Jui-Ting, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Jui-Ting Hsiung,

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

Melissa Soohoo,

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

Csaba P. Kovesdy,

• 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,

• 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,

Background

Higher white blood cell counts (WBC) have been shown to be strongly and independently associated with all-cause mortality in maintenance hemodialysis (HD) and incident peritoneal dialysis patients; however, the association between WBC count and mortality in incident HD patients has been understudied.

Methods

We retrospectively examined a cohort of 109,767 incident HD patients receiving treatment within a large dialysis organization from 2007-2011, with available WBC measurements during the first 91-days of dialysis. Patients were grouped into 6 WBC categories. Using Cox models, we examined the association between WBC count and all-cause mortality with hierarchical adjustments for case-mix variables, albumin and additional laboratory markers of malnutrition and inflammation (MICS).

Results

Mean patient age of the cohort was 63±15 years; 44% of patients were female, 32% were African American, and 58% were diabetic. Mean WBC count was 7.82±2.68 x10³/mm³. Compared to the reference group of WBC 7.0-<8.0 x10³/mm³, we observed a J-shaped association between WBC and mortality. Patients with low WBC (<6.0 x10³/mm³) had a higher risk of mortality (hazard ratio (HR): 1.04 [95% CI: 1.00, 1.08]), and patients with greater WBC (>9.0 x10³/mm³) had the highest risks of mortality in case-mix adjusted models. After further adjustment for albumin and MICS covariates, associations were modestly attenuated; however, patients with WBC >9.0 x10³/mm³ still had a higher mortality risk compared to the referent [figure1].

Conclusion

Among incident HD patients, higher WBC count is associated with higher mortality risk, independent of other markers of malnutrition and inflammation, including albumin. These data suggest that WBC count may need closer monitoring in patients who are new to dialysis, but further studies are needed to examine this relationship.

Funding

• NIDDK Support