Can Subtypes of White Blood Cells Predict Mortality in Hemodialysis Patients?

Objective: To investigate whether increased white blood cell count (WBC) is an independent risk factor for mortality in hemodialysis (HD) patients. There are limited number of studies that evaluate the WBC subtypes and mortality in HD patients. Material and Methods: In this 36 months long prospective study, predictive value of WBC subtypes for mortality was investigated in 910 HD patients (male 55%, diabetes 29.3%, age 59 +/- 14; HD duration 44 +/- 39 months). Results: There was significant correlation between high sensitive C-reactive protein and neutrophils (r= 0.43, p< 0.001) and monocytes (r= 0.24, p< 0.001). During the study 202 (22%) patients died mainly of cardiovascular disease (%57). Survivals at 1,2 and 3 years were calculated with Kaplan Meier analysis and were found as 90%, 80% and %73, respectively. Kaplan Meier analysis showed that increased basal neutrophil count (>5.040/mm(3)), increased monocytes (>740/mm(3)) and decreased lymphocytes (<1.620/mm(3)) were correlated with poor survival. In Cox regression analysis, monocyte count over 1.267/mm(3) and lymphocyte count less than 461/mm(3) were found as independent factors for overall survival after correction for classical risk factors. However, neutrophil count was not correlated with mortality. Conclusion: Increased blood monocyte count and decreased lymphocyte count are independent risk factors for long-term mortality.