Eosinophil count and mortality risk in incident hemodialysis patients

Kang, Duk Hee; Lee, Yu‐Ji; Kleine, Carola Ellen; Lee, Yong Kyu; Park, Christina; Hsiung, Jui Ting; Rhee, Connie M.; Kövesdy, Csaba P.; Kalantar-Zadeh, Kamyar; Streja, Elani

doi:10.1093/ndt/gfz296

Cited by 7 publications

(10 citation statements)

References 31 publications

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“…EOC in men and women showed significant differences both before and after dialysis (190.0 vs. 130.0/μL, p < 0.001; 239.3 vs. 161.9/μL, p < 0.001, respectively) in our study. This is consistent with studies of eosinophils in a healthy population, predialysis CKD patients, and HD patients, all of which reported EOC was higher in men than in women [11,25,26]. These results indicate that gender itself contributes to the different domain value of EOC instead of the effect caused by PD therapy, suggesting gender should be considered when defining the "normal" values of EOC.…”

Section: Discussionsupporting

confidence: 90%

“…Surprisingly, even though older age was a significant risk factor for technique failure in women (with each 1 year increase, HR: 1.021; 95% CI: 1.005–1.037; p = 0.009), the significant association of eosinophilia with technique failure was only observed in women aged <55 years but not in women aged ≥55 years. Similar results were reported for HD patients, which indicated that a higher EOC was more likely to be associated with mortality in younger patients [11]. Together, these data consolidate our hypothesis that estrogen has a role on the function of eosinophils and thus explains in part the differences observed between males and females with eosinophilia.…”

Section: Discussionsupporting

confidence: 88%

“…Eosinophilia is common in hemodialysis (HD) patients in part because of the limited biocompatibility of the dialysis membrane [8, 9]. With the advancement of modern dialyzer membranes, the prevalence of hemodialysis-associated eosinophilia (HAE) has been significantly reduced, accounting for 4.7–23.4% HD patients in recent years [10, 11]. Even though the change in eosinophil count (EOC) is not serious, lower and higher eosinophils are associated with higher all-cause mortality in HD patients [11].…”

Section: Introductionmentioning

confidence: 99%

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Higher Eosinophils Predict Death-Censored Technique Failure in Peritoneal Dialysis Patients

Yang

Fan

et al. 2020

Int Arch Allergy Immunol

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Introduction: Eosinophilia (eosinophil fraction of leukocytes >5%), an indicative parameter for bioincompatibility in various circumstances, is well established in hemodialysis. However, change in eosinophil count (EOC) and its association with death-censored technique failure among peritoneal dialysis (PD) patients remain unclear. Methods: We compared eosinophils before and after PD initiation among 1,432 eligible continuous ambulatory PD patients regularly followed up in our PD center during 2007-2018. Risk factors of earlystage eosinophilia were examined by the logistic regression test. The relationship of early-stage eosinophilia and EOC with death-censored technique failure was examined using the Cox proportional hazards model for overall patients and for men and women separately. Results: After PD initiation, the EOC and percentage of patients with eosinophilia were significantly increased compared with baseline. Being male (odds ratio [OR]: 2.26; 95% confidence interval [CI]: 1.55-3.31; p < 0.001) and higher EOC at baseline (100 cells/μL increase, OR: 1.62; 95% CI: 1.45-1.82; p < 0.001) were risk factors of early-stage eosinophilia after PD initiation. During follow-up, 204 death-censored technique failures were recorded. In fully adjusted models, each with 100 cells/μL increase in EOC, the adjusted hazard ratios (HRs) of technique failure were 1.11 (95% CI: 1.03-1.20; p = 0.009) in the whole cohort, 1.29 (95% CI: 1.10-1.51; p = 0.002) in women, and 1.07 (95% CI: 0.97-1.17; p = 0.196) in men. Eosinophilia was significantly associated with the risk of technique failure for women (HR: 2.24; 95% CI: 1.07-4.70; p = 0.033), which was especially significant for women aged <55 years (HR: 7.61; 95% CI: 1.88-30.90; p = 0.005). Conclusion: EOC was increased significantly after PD initiation, and increased numbers of eosinophils were associated with higher death-censored technique failure in PD patients, especially women.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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Higher Eosinophils Predict Death-Censored Technique Failure in Peritoneal Dialysis Patients

Yang

Fan

et al. 2020

Int Arch Allergy Immunol

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“…In addition, although currently, we have no direct explanation for the higher eosinophil counts seen in HD patients, this may also indicate substantial immune activation during the HD process. Interestingly, changes (both low or high) in eosinophil counts were previously associated with higher all-cause mortality in incident HD patients [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

Neutrophil degranulation and severely impaired extracellular trap formation at the basis of susceptibility to infections of hemodialysis patients

Salti

Khoury

Karem

et al. 2022

BMC Med

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Background Chronic kidney disease patients are at increased risk of mortality with cardiovascular diseases and infections as the two leading causes of death for end-stage kidney disease treated with hemodialysis (HD). Mortality from bacterial infections in HD patients is estimated to be 100–1000 times higher than in the healthy population. Methods We comprehensively characterized highly pure circulating neutrophils from HD and healthy donors. Results Protein levels and transcriptome of HD patients’ neutrophils indicated massive neutrophil degranulation with a dramatic reduction in reactive oxygen species (ROS) production during an oxidative burst and defective oxidative cellular signaling. Moreover, HD neutrophils exhibit severely impaired ability to generate extracellular NET formation (NETosis) in NADPH oxidase-dependent or independent pathways, reflecting their loss of capacity to kill extracellular bacteria. Ectopic hydrogen peroxidase (H2O2) or recombinant human SOD-1 (rSOD-1) partly restores and improves the extent of HD dysfunctional neutrophil NET formation. Conclusions Our report is one of the first singular examples of severe and chronic impairment of NET formation leading to substantial clinical susceptibility to bacteremia that most likely results from the metabolic and environmental milieu typical to HD patients and not by common human genetic deficiencies. In this manner, aberrant gene expression and differential exocytosis of distinct granule populations could reflect the chronic defect in neutrophil functionality and their diminished ability to induce NETosis. Therefore, our findings suggest that targeting NETosis in HD patients may reduce infections, minimize their severity, and decrease the mortality rate from infections in this patient population.

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“…11 and 4 events per 100 patient-months of follow-up, respectively) [20]. In a national cohort of 58 304 incident hemodialysis patients with and without diabetes from a large dialysis organization (LDO), 17 and 7% of patients, respectively, were found to have hypoglycemia as ascertained by monthly predialysis glucose levels [21].…”

Section: Hypoglycemia In Chronic Kidney Diseasementioning

confidence: 99%

Novel approaches to hypoglycemia and burnt-out diabetes in chronic kidney disease

Rhee

Kalantar-Zadeh

Tuttle

2021

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of reviewDiabetes mellitus is a leading cause of chronic kidney disease (CKD) that confers faster kidney disease progression, higher mortality, and various metabolic derangements including hypoglycemia. Recent findingsEven in the absence of diabetes mellitus, growing research demonstrates that CKD patients are at heightened risk for hypoglycemia via multiple pathways. In CKD patients transitioning to end-stage renal disease (ESRD), spontaneous resolution of hyperglycemia and frequent hypoglycemia resulting in reduction and/or cessation of glucose-lowering medications are frequently observed in a phenomenon described as 'burnt-out diabetes'. In non-CKD patients, it is well established that hypoglycemia is causally associated with mortality, with pathways including arrhythmias, sudden cardiac death, stroke, and seizures. Increasing evidence shows that, in CKD and ESRD patients with and without diabetes mellitus, hypoglycemia is associated with cardiovascular complications and mortality risk. SummaryGiven the high prevalence of hypoglycemia in CKD patients and the morbidity and mortality associated with this metabolic complication, a multimodal strategy is needed to prevent dysglycemia, including individualization of glycemic targets, selection of glucose-lowering medications less likely to induce hypoglycemia, medical nutrition therapy administered by trained dietitians, and accurate and precise hypoglycemia detection methods, such as self-monitored blood glucose or continuous glucose monitoring including during dialysis treatment.

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Eosinophil count and mortality risk in incident hemodialysis patients

Cited by 7 publications

References 31 publications

Higher Eosinophils Predict Death-Censored Technique Failure in Peritoneal Dialysis Patients

Higher Eosinophils Predict Death-Censored Technique Failure in Peritoneal Dialysis Patients

Neutrophil degranulation and severely impaired extracellular trap formation at the basis of susceptibility to infections of hemodialysis patients

Novel approaches to hypoglycemia and burnt-out diabetes in chronic kidney disease

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