Elevated white cell count at commencement of peritoneal dialysis predicts overall and cardiac mortality

Johnson, David Wayne, Wiggins, Kathryn Joan, Armstrong, Kirsten Anne, Campbell, Scott Bryan, Isbel, Nicole Maree and Hawley, Carmel Mary (2005) Elevated white cell count at commencement of peritoneal dialysis predicts overall and cardiac mortality. Kidney International, 67 2: 738-743. doi:10.1111/j.1523-1755.2005.67135.x


Author Johnson, David Wayne
Wiggins, Kathryn Joan
Armstrong, Kirsten Anne
Campbell, Scott Bryan
Isbel, Nicole Maree
Hawley, Carmel Mary
Title Elevated white cell count at commencement of peritoneal dialysis predicts overall and cardiac mortality
Journal name Kidney International   Check publisher's open access policy
ISSN 0085-2538
1523-1755
Publication date 2005-02
Sub-type Article (original research)
DOI 10.1111/j.1523-1755.2005.67135.x
Volume 67
Issue 2
Start page 738
End page 743
Total pages 6
Editor S. Klahr
Place of publication London, United Kingdom
Publisher Nature Publishing Group
Collection year 2005
Language eng
Subject 730118 Organs, diseases and abnormal conditions not elsewhere classified
110312 Nephrology and Urology
Formatted abstract
Background.
Higher total white blood cell counts (WCC) have been shown in the general population to be strongly and independently predictive of coronary heart disease and all-cause mortality. The aim of the present study was to evaluate the prognostic value of WCC in patients commencing peritoneal dialysis (PD).

Methods.
A cohort of 323 patients (mean age 55.1 +/- 17.7 years, 54% male, 81% Caucasian) commencing PD at the Princess Alexandra Hospital between January 1, 1998 and March 31, 2003 were prospectively followed until death, completion of PD therapy, or otherwise to the end of the study (January 2, 2004), at which point data were censored. Individuals with failed renal transplants (N= 17) and those with acute infections at the time of PD onset (N= 12) were not included. A multivariate Cox's proportional hazards model was applied to calculate hazard ratios and adjusted survival curves for time to death or cardiac death, adjusting for baseline demographic, clinical, and laboratory characteristics.

Results.
Median actuarial patient survival was 3.9 years [95% confidence interval (CI) 3.2-4.7 years]. The highest quartile of WCC (>9.4 x 10(9)/L) was significantly and independently associated with increased risks of both death from all causes [adjusted hazard ratio (HR) 2.27, 95% CI 1.09-4.74, P < 0.05] and cardiac death (HR 3.75, 95% CI 1.2-11.8, P < 0.05). Other adverse risk factors included older age, lower serum albumin, and the presence of coronary artery disease. Similar associations were found between mortality and PMN count, but not lymphocyte count.

Conclusion.
Elevated baseline WCC or PMN count at the commencement of PD (in the absence of acute infection) strongly predicts all-cause and cardiovascular mortality. These data suggest that new PD patients with higher WCC may warrant closer monitoring and extra attention to modifiable cardiovascular risk factors.
Keyword Urology & Nephrology
Continuous Ambulatory Peritoneal Dialysis
Dialysis Technique Failure
Kidney Failure
Chronic
Lymphocytes
Mortality
Neutrophils
Survival
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2006 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Wed, 15 Aug 2007, 05:38:05 EST