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Published on: March 22, 2022
The prognostic value of peripheral total and differential leukocyte count in renal progression: A community-based
Chiung-Hui Yen1,2, I-Wen Wu3,4,5, Chin-Chan Lee3,4,5
1Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan.
Insights
Systemic inflammation is linked to chronic kidney disease (CKD). Higher neutrophil counts in CKD patients independently predict rapid kidney function decline, offering a potential marker for risk stratification.
Area of Science:
- Nephrology
- Immunology
- Inflammation Research
Background:
- Systemic inflammation is prevalent in chronic kidney disease (CKD) patients.
- Elevated leukocyte counts may indicate subclinical inflammation and disease progression.
- The relationship between leukocyte counts and renal progression in CKD remains unclear.
Purpose of the Study:
- To investigate the association between total and differential leukocyte counts and renal progression in a community-based CKD cohort.
- To identify specific leukocyte subsets that predict rapid decline in kidney function.
Main Methods:
- A two-year community-based cohort study was conducted.
- Evaluated total and differential leukocyte counts in relation to estimated glomerular filtration rate (eGFR) changes.
- Multivariate analysis and ROC curve analysis were used to identify predictors of rapid renal progression.
Main Results:
- A significant negative correlation was observed between leukocyte counts and eGFR.
- Rapid renal progression (≥30% eGFR reduction) was associated with male gender, diabetes, higher uric acid, and elevated neutrophils, monocytes, and eosinophils.
- Peripheral neutrophil count was the sole independent predictor of rapid renal progression (OR=2.760/mm³).
Conclusions:
- CKD patients exhibit hyperinflammation characterized by elevated leukocyte counts.
- Peripheral neutrophil count is a significant independent predictor of rapid renal progression in CKD.
- A neutrophil count cutoff of 2760/mm³ effectively identifies high-risk individuals for accelerated kidney function decline.
Background:
Systemic inflammation is related to chronic kidney disease (CKD) patients. Elevated peripheral leukocyte count may be a herald of increased systemic inflammation and subclinical disease. Inflammation plays an important role in renal progression. The pattern of total and differential leukocyte count in CKD is not well understood. Besides, the association between total and differential leukocyte count and renal progression is still uncertain.
Methods:
We conducted a community-based cohort study with a follow-up period of two years to evaluate the total and differential leukocyte counts and renal progression association.
Results:
In our study population from the community with a total number of 2128, we found 15.7% (335/2128) CKD patients with a mean estimated glomerular filtration rate (eGFR) around 96 ± 26 ml/min/1.73 m2. The peripheral total leukocyte count and also differential leukocyte count were significantly negatively correlated with eGFR. A total of 56 patients (3%) experienced a rapid progression of the kidney with the definition of eGFR reduction changes of 30% or greater within two years. Univariate analysis indicated that rapid renal progression was significantly associated with male gender, co-morbidity of diabetes mellitus (DM), higher uric acid levels, higher peripheral neutrophil, monocyte, and eosinophil counts. However, only the peripheral neutrophil count was positively and independently associated with rapid renal progression after multivariate analysis. The ROC curve analysis found that the optimal cutoff value of peripheral neutrophil count for rapid progression was 2760/ mm3, with an area under the curve of 0.813.
Conclusion:
Hyperinflammation with higher peripheral total and differential leukocyte count was noted in CKD patients. The peripheral neutrophil count was the only independent factor significantly associated with rapid renal progression. The optimal cutoff point of the peripheral neutrophil count with 2760/mm3 is useful for determining the high-risk population for rapid renal progression with a satisfying sensitivity and specificity.
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