Kidney Week

Abstract: PUB139

Association of Monocyte-Lymphocyte Ratio with Cardiovascular Events and All-Cause Mortality in Patients with ESKD

Session Information

• Publication Only

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Kabeil, Ahmed, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Ahmed Kabeil, MD

• Bergeron, Cameron Jackson, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Cameron Jackson Bergeron

• Mallisetty, Yamini, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Yamini Mallisetty, MSc, MPH

• Han, Zhongji, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Zhongji Han, PhD

• Chiu, Chi-Yang, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Chi-Yang Chiu

• Kovesdy, Csaba P., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Csaba P. Kovesdy, MD, FASN

• Sumida, Keiichi, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Keiichi Sumida, MD, PhD, MPH, FASN

Background

Monocyte to lymphocyte ratio (MLR) represents a pro-inflammatory immune microenvironment and has been associated with adverse clinical outcomes, including cardiovascular disease (CVD). However, little is known about its association with clinical outcomes in patients with end-stage kidney disease (ESKD).

Methods

In a nationwide prospective cohort of 952 patients receiving maintenance hemodialysis from 2011-2013, we examined the association of baseline MLR with subsequent risk of CV events (CV-related hospitalization and CV death) and all-cause mortality, using the Kaplan-Meier method and Cox proportional hazards models with adjustment for age, sex, dialysis vintage, vascular access type, BMI, systolic blood pressure, Charlson Comorbidity Index, ischemic heart disease, diabetes mellitus, serum albumin, hemoglobin, infectious hospitalization, culture-positive bacteremia, and antibiotic or antifungal use. MLR was categorized into tertiles (<0.226, 0.226-<0.315, and ≥0.315).

Results

Overall, patients were 60±13 years old; 53% were male; 40% were African American; and 57% were diabetic. The mean dialysis vintage was 4.3±3.8 years. During a median follow-up of 2.2 years, 184 and 207 cases experienced CV events and death, respectively. The rates of CV events and all-cause death were higher in those with higher MLR (log-rank P <0.001, Figure). The adjusted hazard ratios (HRs) [95% CI] of CV events and all-cause mortality for the highest (vs. lowest) tertile was 1.88 [1.29-2.74] and 1.47 [1.02-2.11], respectively. Similar associations were seen when MLR was treated as a continuous variable (1.18 [1.06-1.31] and 1.19 [1.07-1.31], per 0.1 higher MLR, respectively).

Conclusion

A higher MLR was independently associated with higher risk of CV events and all-cause mortality in patients with ESKD, suggesting the potential of MLR as a simple, cost-effective prognostic biomarker in ESKD.