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Low white blood cell count is independently associated with chronic kidney disease progression in the elderly: the CKD-ROUTE study

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Abstract

Background

Elevated white blood cell (WBC) count is a well-known predictor of chronic kidney disease (CKD) progression. However, elderly patients commonly fail to develop a high WBC count in response to several diseased states and may instead present a low WBC count. Therefore, we hypothesized that low WBC count, in addition to high WBC count, is associated with CKD progression in the elderly.

Methods

We conducted a prospective cohort study using 3-year follow-up data from the CKD Research of Outcomes in Treatment and Epidemiology study. In the present study, participants aged over 60 years with pre-dialysis CKD stages G2–G5 were eligible. Patients were stratified into three groups according to WBC count using tertiles (T). The primary outcome was a composite of end-stage renal disease and a 50% reduction in estimated glomerular filtration rate. Data were analyzed using Cox proportional hazard models with adjustments for covariates.

Results

We enrolled 697 patients (males, 69%). The median WBC count was 6100 cells/µl (T1, <5400, n =  222; T2, 5400–6900, n =  235; T3, ≥6900, n = 240). During a median follow-up of 868 days, the primary outcome was observed in 170 patients, whereas 54 patients died. T1 and T3 had significantly higher hazard ratios (HR) than T2 (T1, HR 1.69, 95% confidence interval 1.14–2.51; T3, HR 1.63, 95% confidence interval 1.10–2.41). Moreover, T1 had a significantly higher adjusted HR (1.54, 95% confidence interval 1.00–2.37).

Conclusion

Low WBC count is independently associated with CKD progression in the elderly.

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Author information

Authors and Affiliations

  1. Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan

    Yohei Arai, Eiichiro Kanda, Soichiro Iimori, Shotaro Naito, Sei Sasaki, Eisei Sohara, Tomokazu Okado, Tatemitsu Rai & Shinichi Uchida

  2. Department of Nephrology, Tokyo Kyosai Hospital, 2-3-8 Nakameguro, Meguroku, Tokyo, 153-8934, Japan

    Eiichiro Kanda

  3. Department of Nephrology, Nitobe Memorial Nakano General Hospital, Tokyo, Japan

    Yumi Noda

Authors
  1. Yohei Arai
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  2. Eiichiro Kanda
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  3. Soichiro Iimori
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  4. Shotaro Naito
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  5. Yumi Noda
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  6. Sei Sasaki
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  7. Eisei Sohara
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  8. Tomokazu Okado
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  9. Tatemitsu Rai
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  10. Shinichi Uchida
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Corresponding author

Correspondence to Eiichiro Kanda.

Ethics declarations

Ethical approval

This study protocol was approved by the ethical review board of each institution. The approval numbers are listed below: Tokyo Medical and Dental University, school of medicine (No. 883); Tsuchiura Kyodo General Hospital (No. 212); Tokyo Metropolitan Tama Medical Center (No. 17); JA Toride Medical Center (No. 104); Ome Municipal General Hospital (No. 10); Tokyo Metropolitan Bokutoh Hospital (No. 20); Tokyo Metropolitan Otsuka Hospital (No. 2010-15); Clinical Research Center, Chiba-East National Hospital (No. 15). The research was performed in accordance with the ethical principles of the Declaration of Helsinki. The protocol was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000004461).

Informed consent

Written informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that no conflicts of interest exist.

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Arai, Y., Kanda, E., Iimori, S. et al. Low white blood cell count is independently associated with chronic kidney disease progression in the elderly: the CKD-ROUTE study. Clin Exp Nephrol 22, 291–298 (2018). https://doi.org/10.1007/s10157-017-1441-6

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  • DOI: https://doi.org/10.1007/s10157-017-1441-6

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