White blood cells as a novel mortality predictor in haemodialysis patients

Reddan, Donal; Klassen, Preston S.; Szczech, Lynda A.; Coladonato, Joseph A.; O’Shea, Susan; Owen, William F.; Lowrie, Edmund G.

doi:10.1093/ndt/gfg066

Cited by 180 publications

(142 citation statements)

References 21 publications

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“…However, we did use data on serum albumin, ferritin, and TIBC and WBC count and lymphocyte percentage, which also tend to reflect the presence or absence of inflammation (27,28,31). Another limitation of our analysis is that there is no proven steady state that is required for accurate calculation for nPNA equation.…”

Section: Discussionmentioning

confidence: 99%

Association between Serum Bicarbonate and Death in Hemodialysis Patients

Shinaberger

Regidor

et al. 2006

Clinical Journal of the American Society of Nephrology

140

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Section: Discussionmentioning

confidence: 99%

Association between Serum Bicarbonate and Death in Hemodialysis Patients

Shinaberger

Regidor

et al. 2006

Clinical Journal of the American Society of Nephrology

140

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“…This severe, yet common, complication of ESRD has been shown to correlate with increased morbidity and mortality in this patient population (50) and has been found to be related to lymphocytopenia and to impaired T lymphocyte function (51,52).…”

Section: Alterations Of Adaptive Immune Systemmentioning

confidence: 99%

Aspects of Immune Dysfunction in End-stage Renal Disease

Kato

Chmielewski

Honda

et al. 2008

Clinical Journal of the American Society of Nephrology

877

716

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End-stage renal disease (ESRD) is associated with significantly increased morbidity and mortality resulting from cardiovascular disease (CVD) and infections, accounting for 50% and 20%, respectively, of the total mortality in ESRD patients. It is possible that these two complications are linked to alterations in the immune system in ESRD, as uremia is associated with a state of immune dysfunction characterized by immunodepression that contributes to the high prevalence of infections among these patients, as well as by immunoactivation resulting in inflammation that may contribute to CVD. This review describes disorders of the innate and adaptive immune systems in ESRD, underlining the specific role of ESRD-associated disturbances of Toll-like receptors. Finally, based on the emerging links between the alterations of immune system, CVD, and infections in ESRD patients, it emphasizes the potential role of the immune dysfunction in ESRD as an underlying cause for the high mortality in this patient population and the need for more studies in this area.

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“…Only a few recent studies have shown an association between immune dysfunction and nutritional depletion in patients with chronic disease. In 25 661 patients undergoing haemodialysis a high lymphocyte count and low neutrophil count were found to be associated with high levels of serum albumin and creatinine (Reddan et al 2003). In sixty patients with generalised malignancy classified as well-nourished or malnourished according to weight loss, serum albumin and transferrin as well as to the Karnofsky state of performance (Gogos et al 1998), the absolute numbers of T-cells, the percentages of total Tcells and CD4 + T-cells were found to be lower in malnourished subjects than in well-nourished subjects.…”

Section: Impaired Immune Function As a Results Of Nutritional Depletionmentioning

confidence: 99%

Physiological functions should be considered as true end points of nutritional intervention studies

et al. 2005

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With the beginning of this millennium it has become fashionable to only follow 'evidencebased' practices. This generally-accepted approach cruelly negates experience or intelligent interpretation of pathophysiology. Another problem is that the great 'meta-analysts' of the present era only accept end points that they consider 'hard'. In the metabolic and nutritional field these end points are infection-related morbidity and mortality, and all other end points are considered 'surrogate'. The aim of this presentation is to prove that this claim greatly negates the contribution of more-fundamentally-oriented research, the fact that mortality has multifactorial causes, and that infection is a crude measure of immune function. The following problems should be considered: many populations undergoing intervention have low mortality, requiring studies with thousands of patients to demonstrate effects of intervention on mortality; nutrition is only in rare cases primary treatment, and in many populations is a prerequisite for survival rather than a therapeutic modality; once the effect of nutritional support is achieved, the extra benefit of modulation of the nutritional support regimen can only be modest; cost-benefit is not a valid end point, because the better it is done the more it will cost; morbidity and mortality are crude end points for the effect of nutritional intervention, and are influenced by many factors. In fact, it is a yes or no factor. In the literature the most important contributions include new insights into the pathogenesis of disease, the diminution of diseaserelated adverse events and/or functional improvement after therapy. In nutrition research the negligence of these end points has precluded the development and validation of functional end points, such as muscle, immune and cognitive functions. Disability, quality of life, morbidity and mortality are directly related to these functional variables. It is, therefore, of paramount importance to validate functional end points and to consider them as primary rather than surrogate end points.

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White blood cells as a novel mortality predictor in haemodialysis patients

Cited by 180 publications

References 21 publications

Association between Serum Bicarbonate and Death in Hemodialysis Patients

Association between Serum Bicarbonate and Death in Hemodialysis Patients

Aspects of Immune Dysfunction in End-stage Renal Disease

Physiological functions should be considered as true end points of nutritional intervention studies

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