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Abstract: PO1034

Monocyte-to-Lymphocyte Ratio, an Independent Risk Factor of Survival and Cardiovascular Disease in Hemodialysis Patients: Results from the International MONDO Consortium

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Bright, Rupert Benjamin Graham, Imperial College Healthcare NHS Trust, London, London, United Kingdom
  • Ye, Xiaoling, Renal Research Institute, New York, New York, United States
  • Woollard, Kevin, Imperial College London, London, London, United Kingdom
  • Pusey, Charles D., Imperial College London, London, London, United Kingdom
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
  • Duncan, Neill D., Imperial College Healthcare NHS Trust, London, London, United Kingdom
Background

Patients with ESRD have a high prevalence of chronic inflammation and higher risk of death. Monocytes have a crucial inflammatory role, but there has been limited study to date. This analysis studed the independent relationship between MLR, all-cause and cardiovascular (CV) mortality in a large and ethnically diverse haemodialysis population

Methods

Four cohorts were described by phases of haemodialysis exposure. Kaplan-Meier (KM) curves were applied to explore the association between MLR quartiles with all-cause and CV mortality in the 4 cohorts. Cox proportional hazards models with spline terms (adjusted for age, gender, race, body mass index, diabetic (DM) and congestive heart failure (CHF)) were applied to explore the association between MLR levels and all-cause mortality in the cohorts

Results

21,095 patients were included in acute phase cohort; 19,240 in the early-stable phase cohort, 16,680 in the mid-stable cohort, and 13,839 in the late-stable phase cohort. Notably, patients with higher baseline MLR by quartile tended to be older, male and with a higher percentage of DM and CHF as comorbidities. Lower lymphocyte count and higher neutrophil count, NLR, CRP were associated with higher MLR quartile, consistent with the observed association with other markers of inflammation and malnutrition: lower albumin, phosphate and higher ferritin. Adjusted all-cause and CV mortality was observed to be higher in patients with higher MLR quartile both in the KM and spline analyses (Fig1/2)

Conclusion

There is a positive relationship between higher levels of MLR and adjusted all-cause and CV mortality across all phase cohorts, including long-term follow-up in this large and ethnically diverse haemodialysis population. Higher prevelence of DM and CHF are seen in patients with higher levels of MLR. This work supports findings made previously in more restricted cohorts and warrants further mechanistic investigation