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Association between Monocyte Count and Risk of Incident CKD and Progression to ESRD.
Clin J Am Soc Nephrol. 2017 Apr 03; 12(4):603-613.CJ

Abstract

BACKGROUND AND OBJECTIVES

Experimental evidence suggests a role for monocytes in the biology of kidney disease progression; however, whether monocyte count is associated with risk of incident CKD, CKD progression, and ESRD has not been examined in large epidemiologic studies.

DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS

We built a longitudinal observational cohort of 1,594,700 United States veterans with at least one eGFR during fiscal year 2004 (date of last eGFR during this period designated time zero) and no prior history of ESRD, dialysis, or kidney transplant. Cohort participants were followed until September 30, 2013 or death. Monocyte count closest to and before time zero was categorized in quartiles: quartile 1, >0.00 to ≤0.40 thousand cells per cubic millimeter (k/cmm); quartile 2, >0.40 to ≤0.55 k/cmm; quartile 3, >0.55 to ≤0.70 k/cmm; and quartile 4, >0.70 k/cmm. Survival models were built to examine the association between monocyte count and risk of incident eGFR<60 ml/min per 1.73 m2, risk of incident CKD, and risk of CKD progression defined as doubling of serum creatinine, eGFR decline ≥30%, or the composite outcome of ESRD, dialysis, or renal transplantation.

RESULTS

Over a median follow-up of 9.2 years (interquartile range, 8.3-9.4); in adjusted survival models, there was a graded association between monocyte counts and risk of renal outcomes. Compared with quartile 1, quartile 4 was associated with higher risk of incident eGFR<60 ml/min per 1.73 m2 (hazard ratio, 1.13; 95% confidence interval, 1.12 to 1.14) and risk of incident CKD (hazard ratio, 1.15; 95% confidence interval, 1.13 to 1.16). Quartile 4 was associated with higher risk of doubling of serum creatinine (hazard ratio, 1.22; 95% confidence interval, 1.20 to 1.24), ≥30% eGFR decline (hazard ratio, 1.18; 95% confidence interval, 1.17 to 1.19), and the composite renal end point (hazard ratio, 1.19; 95% confidence interval, 1.16 to 1.22). Cubic spline analyses of the relationship between monocyte count levels and renal outcomes showed a linear relationship, in which risk was higher with higher monocyte count. Results were robust to changes in sensitivity analyses.

CONCLUSIONS

Our results show a significant association between higher monocyte count and risks of incident CKD and CKD progression to ESRD.

Authors+Show Affiliations

Clinical Epidemiology Center, Research and Education Service and.Clinical Epidemiology Center, Research and Education Service and.Clinical Epidemiology Center, Research and Education Service and. Department of Biostatistics, College for Public Health and Social Justice, St. Louis University, St. Louis, Missouri; and.Clinical Epidemiology Center, Research and Education Service and. Department of Medicine and.Clinical Epidemiology Center, Research and Education Service and zalaly@gmail.com. Department of Medicine and. Division of Nephrology, Department of Medicine, US Department of Veterans Affairs St. Louis Health Care System, St. Louis, Missouri. Institute for Public Health, Washington University School of Medicine, St. Louis, Missouri.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

28348030

Citation

Bowe, Benjamin, et al. "Association Between Monocyte Count and Risk of Incident CKD and Progression to ESRD." Clinical Journal of the American Society of Nephrology : CJASN, vol. 12, no. 4, 2017, pp. 603-613.
Bowe B, Xie Y, Xian H, et al. Association between Monocyte Count and Risk of Incident CKD and Progression to ESRD. Clin J Am Soc Nephrol. 2017;12(4):603-613.
Bowe, B., Xie, Y., Xian, H., Li, T., & Al-Aly, Z. (2017). Association between Monocyte Count and Risk of Incident CKD and Progression to ESRD. Clinical Journal of the American Society of Nephrology : CJASN, 12(4), 603-613. https://doi.org/10.2215/CJN.09710916
Bowe B, et al. Association Between Monocyte Count and Risk of Incident CKD and Progression to ESRD. Clin J Am Soc Nephrol. 2017 Apr 3;12(4):603-613. PubMed PMID: 28348030.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between Monocyte Count and Risk of Incident CKD and Progression to ESRD. AU - Bowe,Benjamin, AU - Xie,Yan, AU - Xian,Hong, AU - Li,Tingting, AU - Al-Aly,Ziyad, Y1 - 2017/03/27/ PY - 2016/09/12/received PY - 2017/01/18/accepted PY - 2017/3/30/pubmed PY - 2017/12/20/medline PY - 2017/3/29/entrez KW - Disease Progression KW - ESRD KW - Epidemiologic Studies KW - Epidemiology and outcomes KW - Follow-Up Studies KW - Kidney Failure, Chronic KW - Monocytes KW - Renal Insufficiency, Chronic KW - United States KW - Veterans KW - chemokine KW - chemokine receptor KW - chronic kidney disease KW - clinical epidemiology KW - creatinine KW - eGFR decline KW - eGFR slope KW - end stage kidney disease KW - kidney KW - kidney transplantation KW - renal dialysis KW - renal function decline KW - renal progression KW - white blood cell SP - 603 EP - 613 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 12 IS - 4 N2 - BACKGROUND AND OBJECTIVES: Experimental evidence suggests a role for monocytes in the biology of kidney disease progression; however, whether monocyte count is associated with risk of incident CKD, CKD progression, and ESRD has not been examined in large epidemiologic studies. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS: We built a longitudinal observational cohort of 1,594,700 United States veterans with at least one eGFR during fiscal year 2004 (date of last eGFR during this period designated time zero) and no prior history of ESRD, dialysis, or kidney transplant. Cohort participants were followed until September 30, 2013 or death. Monocyte count closest to and before time zero was categorized in quartiles: quartile 1, >0.00 to ≤0.40 thousand cells per cubic millimeter (k/cmm); quartile 2, >0.40 to ≤0.55 k/cmm; quartile 3, >0.55 to ≤0.70 k/cmm; and quartile 4, >0.70 k/cmm. Survival models were built to examine the association between monocyte count and risk of incident eGFR<60 ml/min per 1.73 m2, risk of incident CKD, and risk of CKD progression defined as doubling of serum creatinine, eGFR decline ≥30%, or the composite outcome of ESRD, dialysis, or renal transplantation. RESULTS: Over a median follow-up of 9.2 years (interquartile range, 8.3-9.4); in adjusted survival models, there was a graded association between monocyte counts and risk of renal outcomes. Compared with quartile 1, quartile 4 was associated with higher risk of incident eGFR<60 ml/min per 1.73 m2 (hazard ratio, 1.13; 95% confidence interval, 1.12 to 1.14) and risk of incident CKD (hazard ratio, 1.15; 95% confidence interval, 1.13 to 1.16). Quartile 4 was associated with higher risk of doubling of serum creatinine (hazard ratio, 1.22; 95% confidence interval, 1.20 to 1.24), ≥30% eGFR decline (hazard ratio, 1.18; 95% confidence interval, 1.17 to 1.19), and the composite renal end point (hazard ratio, 1.19; 95% confidence interval, 1.16 to 1.22). Cubic spline analyses of the relationship between monocyte count levels and renal outcomes showed a linear relationship, in which risk was higher with higher monocyte count. Results were robust to changes in sensitivity analyses. CONCLUSIONS: Our results show a significant association between higher monocyte count and risks of incident CKD and CKD progression to ESRD. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/28348030/Association_between_Monocyte_Count_and_Risk_of_Incident_CKD_and_Progression_to_ESRD_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=28348030 DB - PRIME DP - Unbound Medicine ER -