The interdependence of trajectories in patient parameters, such as albumin and white blood cell count, may suggest certain disease processes. In the year leading up to dialysis initiation, patients’ clinical parameters shift in predictable and surprising ways, according to a new study presented at the National Kidney Foundation’s 2019 Spring Clinical Meetings in Boston.
“Much of the clinical attention is usually given to meeting target ranges of individual clinical parameters, while less focus is given to small longitudinal changes in patient parameters and their correlation with each other,” Dugan Maddux, MD, Vice President of Kidney Disease Initiatives for Fresenius Medical Care North America, told Renal & Urology News . “Yet the clusters of trajectories may describe pathophysiologic processes and reveal opportunities to improve a patient’s health status and outcomes at the time of dialysis start.”
Dr Maddux and colleagues investigated changes in key laboratory parameters 12 months before progression to end-stage renal disease (ESRD) in 9103 patients on the Acumen chronic kidney disease registry during 2009 to 2018. The researchers described patterns as estimated glomerular filtration rate (eGFR), albumin, and white blood cell count shifted. All results were corrected for race and age.
As eGFR declined, hemoglobin, sodium, and calcium also trended downward, whereas phosphate and white blood cell counts increased. “We expected that declines in eGFR would correlate to declines in hemoglobin due to decreased erythropoietin production,” Dr Maddux said. “We anticipated that eGFR decline also would correlate with increases in systolic blood pressure due to fluid overload, but we did not find any noticeable relationship between these variables.”
As serum albumin decreased, hemoglobin, phosphate, sodium, and corrected calcium also decreased, whereas white blood cell count increased. “Declines in albumin with concurrent increases in white blood cell count may suggest strong inflammatory responses related to deteriorating kidney function,” Dr Maddux said. Declines in phosphorus likely indicate worsened nutrition before dialysis initiation, she noted.
As white blood cell counts rose, albumin, phosphate, sodium, and eGFR all trended downward. Patients with higher white blood cell counts had higher body mass index. “Increases in white blood cell counts along with BMI suggests that inflammation and fluid overload are related. Or there could be other pathophysiology processes that are occurring.”
The study was funded by Fresenius Medical Care.
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Blanchard T, Usvyat L, Kotanko P, et al. Relationships between changes in clinical parameters in 12 months leading to dialysis initiation. Poster presented at the National Kidney Foundation’s 2019 Spring Clinical Meetings in Boston, May 8-12, 2019. Poster 289.
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