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Abstract: SA-PO1032

Association of White Blood Cell Count and Cause-Specific Mortality in Incident Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Zai, Tiffany, University of California at Irvine, Orange, California, United States
  • Nguyen, Steven, University of California at Irvine, Orange, California, United States
  • Aguirre, Antonio, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Park, Christina, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Hsiung, Jui-Ting, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Rhee, Connie, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
Background

Previous studies have shown higher white blood cell (WBC) counts to be strongly and independently associated with all-cause mortality in incident maintenance hemodialysis (HD) patients. However, the association between WBC count and cause-specific mortality in incident HD patients is unknown.

Methods

In a retrospective observational cohort study of 109,767 HD patients from a large US dialysis organization (2007-2011), we examined cardiovascular (CV) and infectious mortality associations with baseline WBC. Using Cox models, we examined the associations with three 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. Patients with higher WBC levels (≥8.0 x103/mm3) had a higher CV and infectious mortality risk compared to the reference group (7-<8.0 x103/mm3) in baseline models, and across all levels of adjustment. In the fully adjusted models, compared to the reference, patients with WBC ≥10.0 x103/mm3 had a 22% higher risk of CV mortality (hazard ratio [HR]: 1.22, 95% CI: 1.14, 1.30) and a 58% higher risk of infectious mortality (HR: 1.58, 95%CI: 1.38, 1.82) [Figure].

Conclusion

Among incident HD patients, higher WBC count is associated with higher CV and infectious mortality risk, independent of other markers of malnutrition and inflammation, including albumin. These data suggest that higher WBC may be indicative of stronger risk of infectious mortality outcomes but further studies are needed to ascertain its use as a predictive marker in HD patients.

Funding

  • NIDDK Support