Abstract
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. 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. 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. 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.
Highlights
Chronic kidney disease (CKD) patients had a relatively worse prognosis, with a higher mortality rate due to cardiovascular deaths, infection, and stroke [1]
The peripheral total leukocyte count and differential leukocyte count were significantly negatively correlated with estimated glomerular filtration rate (eGFR)
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
Summary
Chronic kidney disease (CKD) patients had a relatively worse prognosis, with a higher mortality rate due to cardiovascular deaths, infection, and stroke [1]. Inflammation is related to CKD with the characteristic of persistent low-grade chronic systemic inflammation [2]. These typical connections of malnutrition, inflammation, and atherosclerosis in CKD patients have been named malnutrition-inflammation-atherosclerosis syndrome (MIA syndrome) [3]. Proinflammatory cytokines like interleukin -1 and tumor necrosis factor-alpha play a major role in the onset of metabolic alterations in CKD patients. Many elements contribute to the inflammatory status of CKD, including increased production of proinflammatory cytokines, oxidative stress and acidosis, chronic and recurrent infections, altered metabolism of adipose tissue, and gut microbiota dysbiosis [2]. Systemic inflammation is related to chronic kidney disease (CKD) patients. The association between total and differential leukocyte count and renal progression is still uncertain
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