An increase in
white blood cell (WBC) count is an independent predictor of mortality in
hemodialysis (HD) patients. However, few studies have assessed the association of specific WBC subtypes with mortality. We prospectively studied the predictive value of WBC subtypes for total and
cardiovascular death in 333 HD patients (age 63 +/- 12 years; HD duration 129 +/- 109 months) during a 40-month of follow-up. There was a significant and
positive correlation between highly sensitive
C-reactive protein and
neutrophil (r = 0.28, p < 0.01) and
monocyte (r = 0.20, p < 0.01) counts by a
non-parametric Spearman rank analysis.
Blood monocyte counts were significantly
correlated inversely with
ankle-brachial pressure index (r = -0.24, p < 0.01).
Kaplan-Meier analysis revealed that basal
neutrophil (>4,060/microl) and
monocyte (>270/microl) counts in the highest tertile had a significantly lower survival rate compared to the middle and the lowest tertiles, respectively (p < 0.03). Cox hazards analysis after adjustment for other conventional
risk factors revealed that
monocyte counts of >270/microl became a determinant of total death compared with those of <180/microl (hazards ratio 1.98 [1.10-3.57], p = 0.02). In contrast,
neutrophil and
lymphocyte counts were not associated with mortality. Our findings suggest that an increased
blood monocyte count is an independent predictor of long-term mortality in chronic HD patients.
