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Mitsopoulos E, Lysitska A, Zanos S, Mplatsa A, Alexandrou ME, Kevrekidou S, Stroppou P, Zazopoulou O, Kalliara TA, Voudouri A, Pateinakis P, Manou E, Kyriklidou P, Papadopoulou D. Normal white blood cell counts predict long-term mortality of hemodialysis patients. Int Urol Nephrol 2020; 52:783-790. [PMID: 32157617 DOI: 10.1007/s11255-020-02431-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/23/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE It is unclear whether normal white blood cell (WBC) counts are predictive of subsequent mortality in hemodialysis patients. METHODS All patients aged 17 years or more, who initiated hemodialysis at a tertiary Hospital from January 2000 to August 2017 with a dialysis vintage of greater than 90 days and normal median WBC count of their first dialysis year were included in the study. They were followed until they died, transferred to other dialysis facilities, switched to peritoneal dialysis, received a renal transplant or reached the end of the study (August 31, 2018). Cox regression was used to estimate hazard ratios for mortality of tertiles of WBC counts, adjusting for baseline demographic, clinical and laboratory variables. RESULTS 611 patients [median (interquartile range) age 65.2 (53.3-72.6) years, 62.4% male] were studied. During a median follow-up of 3.9 (1.6-7.2) years, 270 participants died. Patients in the mid- (6.25-7.73 × 103/μL, n = 203) and top-tertile (7.73-10.50 × 103/μL, n = 203) of normal WBC counts had significantly higher mortality than patients in the bottom-tertile (3.50-6.25 × 103/μL, n = 205). The adjusted hazard ratio for mortality relative to the bottom-tertile was 1.54, 95% confidence interval (CI) 1.05-2.25 and 2.20, 95% CI 1.46-3.32, for the mid- and top-tertiles, respectively. CONCLUSIONS In hemodialysis patients, higher WBC count within the normal range is associated with increased long-term mortality. This finding is described for the first time and provides further insight into the clinical significance of a "normal" WBC count result in dialysis patients.
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Affiliation(s)
- Efstathios Mitsopoulos
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece.
| | - Aikaterini Lysitska
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Stavros Zanos
- Center for Bioelectronic Medicine & Biomedical Science, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Aikaterini Mplatsa
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Maria-Eleni Alexandrou
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Sofia Kevrekidou
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Persia Stroppou
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Ourania Zazopoulou
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Theodora-Anastasia Kalliara
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Anastasia Voudouri
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Panagiotis Pateinakis
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Eleni Manou
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Parthena Kyriklidou
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Dorothea Papadopoulou
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
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