TY - JOUR
T1 - Biphasic Dynamics of Inflammatory Markers Following Hemodialysis Initiation: Results From the International MONitoring Dialysis Outcome Initiative
AU - Yousif, D.E.
AU - Ye, X.L.
AU - Stuard, S.
AU - Berbessi, J.
AU - Guinsburg, A.M.
AU - Usvyat, L.A.
AU - Raimann, J.G.
AU - Kooman, J.P.
AU - van der Sande, F.M.
AU - Duncan, N.
AU - Woollard, K.J.
AU - Bright, R.
AU - Pusey, C.
AU - Gupta, V.
AU - Ix, J.H.
AU - Kotanko, P.
AU - Malhotra, R.
N1 - Funding Information:
The authors thank all the kidney centers in the different countries contributing to this analysis. This work was supported by National Institute of Diabetes and Digestive and Kidney Diseases K23 award (DK132680-01 [to RM]).
Publisher Copyright:
© 2022 International Society of Nephrology
PY - 2022/1/1
Y1 - 2022/1/1
N2 - Introduction: Inflammation is highly prevalent among patients with end-stage kidney disease and is associated with adverse outcomes. We aimed to investigate longitudinal changes in inflammatory markers in a diverse international incident hemodialysis patient population.Methods: The MONitoring Dialysis Outcomes (MONDO) Consortium encompasses hemodialysis data-bases from 31 countries in Europe, North America, South America, and Asia. The MONDO database was queried for inflammatory markers (total white blood cell count [WBC], neutrophil count, lymphocyte count, serum albumin, and C-reactive protein [CRP]) and hemoglobin levels in incident hemodialysis patients. Laboratory parameters were measured every month. Patients were stratified by survival time (#6 months, >6 to 12 months, >12 to 18 months, >18 to 24 months, >24 to 30 months, >30 to 36 months, and >36 months) following dialysis initiation. We used cubic B-spline basis function to evaluate temporal changes in inflammatory parameters in relationship with patient survival. Results: We studied 18,726 incident hemodialysis patients. Their age at dialysis initiation was 71.3 +/- 11.9 years; 10,802 (58%) were males. Within the first 6 months, 2068 (11%) patients died, and 12,295 patients (67%) survived >36 months (survivor cohort). Hemodialysis patients who died showed a distinct biphasic pattern of change in inflammatory markers where an initial decline of inflammation was followed by a rapid rise that was consistently evident approximately 6 months before death. This pattern was similar in all patients who died and was consistent across the survival time intervals. In contrast, in the survivor cohort, we observed initial decline of inflammation followed by sustained low levels of inflammatory biomarkers.Conclusion: Our international study of incident hemodialysis patients highlights a temporal relationship between serial measurements of inflammatory markers and patient survival. This finding may inform the development of prognostic models, such as the integration of dynamic changes in inflammatory markers for individual risk profiling and guiding preventive and therapeutic interventions.
AB - Introduction: Inflammation is highly prevalent among patients with end-stage kidney disease and is associated with adverse outcomes. We aimed to investigate longitudinal changes in inflammatory markers in a diverse international incident hemodialysis patient population.Methods: The MONitoring Dialysis Outcomes (MONDO) Consortium encompasses hemodialysis data-bases from 31 countries in Europe, North America, South America, and Asia. The MONDO database was queried for inflammatory markers (total white blood cell count [WBC], neutrophil count, lymphocyte count, serum albumin, and C-reactive protein [CRP]) and hemoglobin levels in incident hemodialysis patients. Laboratory parameters were measured every month. Patients were stratified by survival time (#6 months, >6 to 12 months, >12 to 18 months, >18 to 24 months, >24 to 30 months, >30 to 36 months, and >36 months) following dialysis initiation. We used cubic B-spline basis function to evaluate temporal changes in inflammatory parameters in relationship with patient survival. Results: We studied 18,726 incident hemodialysis patients. Their age at dialysis initiation was 71.3 +/- 11.9 years; 10,802 (58%) were males. Within the first 6 months, 2068 (11%) patients died, and 12,295 patients (67%) survived >36 months (survivor cohort). Hemodialysis patients who died showed a distinct biphasic pattern of change in inflammatory markers where an initial decline of inflammation was followed by a rapid rise that was consistently evident approximately 6 months before death. This pattern was similar in all patients who died and was consistent across the survival time intervals. In contrast, in the survivor cohort, we observed initial decline of inflammation followed by sustained low levels of inflammatory biomarkers.Conclusion: Our international study of incident hemodialysis patients highlights a temporal relationship between serial measurements of inflammatory markers and patient survival. This finding may inform the development of prognostic models, such as the integration of dynamic changes in inflammatory markers for individual risk profiling and guiding preventive and therapeutic interventions.
KW - albumin
KW - dynamics
KW - end-stage kidney disease
KW - inflammation
KW - mortality
KW - neutrophil-lymphocyte ratio
KW - INTERDIALYTIC WEIGHT-GAIN
KW - NUTRITIONAL COMPETENCE
KW - OXIDATIVE STRESS
KW - BLOOD-PRESSURE
KW - MORTALITY
KW - SURVIVAL
KW - HYPOALBUMINEMIA
KW - PARAMETERS
KW - PREDICTORS
KW - DEATH
U2 - 10.1016/j.ekir.2022.10.020
DO - 10.1016/j.ekir.2022.10.020
M3 - Article
C2 - 36644346
SN - 2468-0249
VL - 8
SP - 75
EP - 80
JO - Kidney International Reports
JF - Kidney International Reports
IS - 1
ER -