SUPERIOR SURVIVAL OF INCIDENT PATIENTS ON HIGH-VOLUME ONLINE HEMODIAFILTRATION COMPARED TO HIGH-FLUX HEMODIALYSIS

51st Congress of the European-Renal-Association(ERA)/European-Dialysis-and-Transplant-Association (EDTA) -- MAY 31-JUN 03, 2014 -- Amsterdam, NETHERLANDSWOS: 000338013500076European Renal Assoc, European Dialysis & Transplant Asso

Overview of the cytokine panel and the locations of the 80 cytokines including the internal asssay controls and representative spot blot.

<p> Blue letters and boxes indicate the positive controls, red letters and boxes show the negative controls.</p

Results of the normalized densitometric quantification of the semiquantitative analyses of the cytokine expression patterns in HBoV positive and negative patients and comparison to HBoV infected and mock infected cell cultures.

<p> Panel <b>A</b> shows an overview of the entire HBoV positive patient cohort vs. the HBoV negative control group. In panel <b>B</b> the HBoV positive group and the control group were divided into HHV positive and HHV negative patients in order to identify HBoV unspecific effects on the expression of cytokines. Panel <b>C</b> displays the results of the cell culture experiments. Only those cytokines are displayed that were regulated in the patients/control cohorts. Normalization was performed against the assay internal controls and the total protein content of the respective sample. RDM, relative density measurement. Panel <b>D</b> shows SAS boxplots of those parameters, for which a statistical or local significance was identified. The lines in the boxes show the median, crosses and circles indicate the mean.</p

Relationship of Neutrophil-to-Lymphocyte Ratio and Serum Albumin Levels with C-Reactive Protein in Hemodialysis Patients: Results from 2 International Cohort Studies

Background/Aim: The neutrophil-to-lymphocyte ratio (NLR), defined as the neutrophil count divided by lymphocyte count, is an inexpensive and readily available parameter, which may serve as a surrogate for inflammation markers, such as C-reactive protein (CRP). The aim of this study was to determine the utility of NLR in the prediction of elevated CRP levels in hemodialysis (HD) patients. Methods: We analyzed 43,272 HD patients from 2 distinct cohorts within the Monitoring Dialysis Outcomes research collaboration in whom contemporaneous measurements of neutrophil and lymphocyte counts, serum albumin and CRP levels were available. Logistic regression was used to determine the relationship of trichotomized NLR (5.0) and albumin levels (4.0 g/dl) with elevated CRP levels (>10.0, >20.0 and >30.0 mg/l). Congruence of the prediction models was examined by comparing the regression parameters and by cross-validating each regression equation within the other cohort. Results: We found that NLR >5.0 vs. 10.0 mg/l. Stepwise increase in odds ratio for CRP >10.0 mg/l was observed with the combination of high NLR and low albumin levels (NLR >5.0 and albumin <3.1) (cohort 1: OR 7.6; p < 0.0001 and cohort 2: OR 11.9; p < 0.0001). Cross-validation of the 2 regression models revealed a predictive accuracy of 0.68 and 0.69 in the respective cohorts. Conclusion: This study suggests that NLR could serve as a potential surrogate marker for CRP. Our results may add to diagnostic abilities in settings where CRP is not measured routinely in HD patients. NLR is easy to integrate into daily practice and may be used as a marker of systemic inflammation. (C) 2015 S. Karger AG, Base

Body Composition and Survival in Dialysis Patients: Results from an International Cohort Study

BACKGROUND AND OBJECTIVES: High body mass index appears protective in hemodialysis patients, but uncertainty prevails regarding which components of body composition, fat or lean body mass, are primarily associated with survival. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data between April 2006 and December 2012 were extracted from the Fresenius Medical Care Europe subset of the international MONitoring Dialysis Outcomes initiative. Fresenius Medical Care Europe archives a unique repository of predialysis body composition measurements determined by multifrequency bioimpedance (BCM Body Composition Monitor). The BCM Body Composition Monitor reports lean tissue indices (LTIs) and fat tissue indices (FTIs), which are the respective tissue masses normalized to height squared, relative to an age- and sex-matched healthy population. The relationship between LTI and FTI and all-cause mortality was studied by Kaplan–Meier analysis, multivariate Cox regression, and smoothing spline ANOVA logistic regression. RESULTS: In 37,345 hemodialysis patients, median (25th–75th percentile) LTI and FTI were 12.2 (10.3–14.5) and 9.8 (6.6–12.4) kg/m(2), respectively. Median (25th–75th percentile) follow-up time was 266 (132–379) days; 3458 (9.2%) patients died during follow-up. Mortality was lowest with both LTI and FTI in the 10th–90th percentile (reference group) and significantly higher at the lower LTI and FTI extreme (hazard ratio [HR], 3.37; 95% confidence interval [95% CI], 2.94 to 3.87; P<0.001). Survival was best with LTI between 15 and 20 kg/m(2) and FTI between 4 and 15 kg/m(2) (probability of death during follow-up: <5%). When taking the relation between both compartments into account, the interaction was significant (P=0.01). Higher FTI appeared protective in patients with low LTI (HR, 3.37; 95% CI, 2.94 to 3.87; P<0.001 at low LTI–low FTI, decreasing to HR, 1.79; 95% CI, 1.47 to 2.17; P<0.001 at low LTI–high FTI). CONCLUSIONS: This large international study indicates best survival in patients with both LTI and FTI in the 10th–90th percentiles of a healthy population. In analyses of body composition, both lean tissue and fat tissue compartments and also their relationship should be considered