Relative Thrombocytosis Predicts Poor Outcomes in Patients with Advanced Chronic Kidney Disease

Ping-Min Chen ； Ping-Yu Chen ； Chun-Fu Lai ； Shao-Yu Yang ； Vin-Cent Wu ； Tze-Wah Kao ； Jenq-Wen Huang ； Wen-Chih Chiang ； Chih-Kang Chiang ； Shuei-Liong Lin ； Yung-Ming Chen ； Tzong-Shinn Chu ； Ming-Shiou Wu ； Kwan-Dun Wu ； Tun-Jun Tsai ； Kuan-Yu Hung

《Acta Nephrologica》 30卷4期 (2016/12) Pp. 178-186

https://doi.org/10.6221/AN.2016005

摘要

BACKGROUND: Relative thrombocytosis represents a key inflammatory marker and correlates well with renal cachexia and cardiovascular death in dialysis patients. However, its significance in chronic kidney disease (CKD) is unknown. METHOD: A total of 428 patients who visited the nephrology out-patient clinic with advanced CKD, between the ages of 20 ～ 85, were enrolled. All patients were in stage 3 ～ 5 of CKD. Laboratory examinations and Malnutrition-Inflammation scores (MIS) were recorded for all patients. The primary outcomes included long-term renal replacement therapy and mortality. Multivariate Cox regression models were used to address each risk factor in this cohort. RESULTS: We demonstrated a U shaped distribution of MIS as stratified by platelet counts. Those with platelet counts of 300 ～ 400 K/μL had higher MIS, and the high sensitive C-reactive protein levels were highest in those with platelet counts ＞ 400 K/μL. These two groups were both predicted to be at higher risk of progression to end stage renal disease (HR 1.987 & 3.705, P = 0.034 & 0.035), while the thrombocytopenia group had significant highest risk of mortality. CONCLUSION: Relative thrombocytosis is closely associated with malnutrition-inflammation in patients with advanced CKD, and could serve as a surrogate marker to predict future outcomes. Thrombocytopenia, on the other hand, could represent the severity of viral hepatitis and be indicative of a higher mortality rate.

關鍵字

chronic kidney disease ； inflammation ； thrombocytosis