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Abstract: PO1160

Biphasic Dynamics of Inflammatory Biomarkers Following Dialysis Initiation: Results from the MONDO Initiative

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Ye, Xiaoling, Renal Research Institute, New York, New York, United States
  • Yousif, Dalia Elrashid M, Renal Research Institute, New York, New York, United States
  • Usvyat, Len A., Fresenius Medical Care AG und Co KGaA, Waltham, Massachusetts, United States
  • Stuard, Stefano, Fresenius Medical Care AG und Co KGaA, Bad Homburg, Hessen, Germany
  • Guinsburg, Adrian M., Fresenius SE & Co KGaA, Buenos Aires, Argentina
  • Kooman, Jeroen, Maastricht University Medical Center, Maastricht, Netherlands
  • van der Sande, Frank, Maastricht University Medical Center, Maastricht, Netherlands
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States

Inflammation is highly prevalent among patients (pts) with end stage kidney disease and is associated with adverse outcomes. We aimed to investigate in a large diverse international cohort of incident hemodialysis (HD) pts firstly the dynamics of inflammatory indicators, namely white blood cells (WBC), neutrophil-to-lymphocyte ratio (NLR), serum albumin (lab) and C-reactive protein (CRP), following initiation of HD. Secondly their predictive power over all-cause of death.


We included all incident in-center adult HD pts treated 01/2000 to 12/2012 with ≥ 1 neutrophils, lymphocytes, WBC, and CRP values within the study periods. Following HD initiation, pts were stratified into 7 subgroups: 6 semi-annual groups according to the dialysis vintage at the time of the pts’ death (0 to 6; 7 to 12; 13 to 18; 19 to 24; 25 to 30; 31 to 36 months) and a survivor group (pts who survived ≥37 months). Cubic smoothing spline functions were applied to study the trends of each marker. Receiver Operating Characteristic Curve (ROC) Analyses were performed to evaluate the predictive power of each of the markers with 1st year as the baseline and the following 1 year as the follow-up.


In total, 18,276 incident pts who were treated in 25 countries were included. WBC, NLR (Figure 1), and CRP declined sharply after HD initiation and increased before death, while started & remained low in the survivors. In general, WBC, NLR, and CRP were highest at HD initiation and prior to death in non-survivors. Alb levels increased after HD initiation and remained high in the survivor cohort. In contrast, lab levels dropped significantly before death. Alb (AUC: 0.66), CRP (AUC: 0.64), and NLR (AUC: 0.62) all show stronger predictive power than WBC (AUC: 0.55) (Figure 2).


In non-survivors, NLR, WBC, and CRP showed a similar trend after HD initiation and before death. As CRP is not a routinely used marker in many regions of the world and NLR has near comparable predictive power, this marker could be used as an alternative indicator of inflammation in resource-limited areas.