Relationships of Total Lymphocyte Count and Subpopulation Lymphocyte Counts with the Nutritional Status in Patients Undergoing Hemodialysis/Peritoneal Dialysis

Ye Na Kim; Ho Sik Shin

doi:10.7180/kmj.2017.32.1.58

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Kim and Shin: Relationships of Total Lymphocyte Count and Subpopulation Lymphocyte Counts with the Nutritional Status in Patients Undergoing Hemodialysis/Peritoneal Dialysis

Original Article

Kosin Medical Journal 2017;32(1):58-71.

Published online: 19 January 2017

DOI: https://doi.org/10.7180/kmj.2017.32.1.58

Relationships of Total Lymphocyte Count and Subpopulation Lymphocyte Counts with the Nutritional Status in Patients Undergoing Hemodialysis/Peritoneal Dialysis

Ye Na Kim, Ho Sik Shin

Department of Internal Medicine, College of Medicine, Kosin University, Busan, Korea

Corresponding Author: Ho Sik Shin, Department of Internal Medicine, Kosin University College of Medicine, Kosin University, 262, Gamcheon-ro, Seo-gu, Busan 49267, Korea Tel: +82-51-990-6250 Fax: +82-51-248-5686 E-mail: danieljoseph@hanmail.net

Received 24 September 201515 December 2015 Accepted 11 January 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Dialysis patients’ nutritional indicators are quite subjective and complex and cannot be easily measured in clinical settings. Based on previous reports that total lymphocyte count (TLC) and subpopulation lymphocyte counts (SLCs) are associated with nutritional status in patients with dialysis, we designed this study to examine the relationships of the TLC and SLCs with clinical outcome and nutritional status in patients undergoing maintenance hemodialysis (HD) and peritoneal dialysis (PD).

Methods

In this prospective, observational study, we enrolled 66 patients (50 HD patients and 16 PD patients) receiving stable maintenance dialysis. We evaluated the baseline parameters of height; weight; TLC; SLCs expressing CD3, CD4, CD8 and CD19; CBC; iron profile (iron, TIBC, ferritin); BUN; Cr; Na; K; total CO2; Ca; P; iPTH; protein; albumin; total cholesterol; HDL; LDL; uric acid and CRP and calculated Onodera’s prognostic nutritional index (OPNI) and the Geriatric Nutritional Risk Index (GNRI) at baseline and three months. To analyze differences in the TLC and SLCs between the HD group and the PD group, we performed an independent samples t-test. Logistic regression analysis was performed to predict malnutrition in dialysis patients. In addition, to analyze changes in TLC, SLCs expressing each marker (CD3, CD4, CD8 and CD19) and other nutritional markers, we performed general linear model (GLM)-repeated measures ANOVA.

Results

Mean age was 55.8 ± 12.7 years in HD paitents and 49.8 ± 14.5 years in PD patients. The duration of dialysis was 59.7 ± 52.9 months in HD patients and 66.1 ± 33.6 years in PD patients. Logistic regression analysis revealed that patients aged 60 years or older, women, and those whose CD19 SLCs were lower than 100 had a higher risk of developing malnutrition. In GLM-repeated measures ANOVA, CD19 SLCs were significantly higher in women and in patients with a shorter period of dialysis.

Conclusions

Our results indicate that GNRI, OPNI, TLC and SLCs (especially CD19 count) may be significant nutritional markers in HD and PD patients.

Keywords: Dialysis, Lymphocyte Count, Total Lymphocyte Counts

REFERENCES

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Table 1.

Clinical characteristics of 66 dialysis patients according to methods of dialysis at start of the study

Variables	HD (n=50)	PD (n=16)	Pvalue
Age	55.8 ± 12.7	49.8 ± 14.5	0.127
Sex (Male/Female)	28/22	10/6	0.774
DM	18 (36%)	7 (43.8%)	0.768
Duration of dialysis (months)	59.7 ± 52.9	66.1 ± 33.6	0.653
Body Mass Index	21.3 ± 2.5	23.8 ± 4.1	0.005
GNRI	100.1 ± 8.4	99.2 ± 8.1	0.708
OPNI	47.0 ± 4.6	39.5 ± 4.3	0.003
Kt/V	1.68 ± 0.22	1.85 ± 0.36	0.034
Urea Reduction Rate (%)	75.0 ± 4.5	NA	NA
TLCs (/㎣)	1597 ± 512	1105 ± 658	0.019
CD3 count (/㎣)	1015 ± 400	964 ± 366	0.655
CD4 count (/㎣)	632 ± 260	585 ± 231	0.523
CD8 count (/㎣)	384 ± 171	366 ± 171	0.731
CD19 count (/㎣)	132 ± 85	127 ± 84	0.831
CD4/CD8 ratio	1.8 ± 0.7	1.7 ± 0.7	0.835
Hemoglobin (g/dL)	10.9 ± 0.6	11.3 ± 1.1	0.141
Iron (ug/dL)	88.6 ± 34.8	103.6 ± 43.9	0.195
TIBC (ug/dL)	244.9 ± 35.5	261.1 ± 49.1	0.182
TSAT (%)	37.0 ± 16.5	41.1 ± 19.6	0.457
Ferritin (ng/mL)	367.5 ± 275.6	306.4 ± 204.4	0.458
BUN (mg/dL)	64.8 ± 19.5	64.0 ± 16.2	0.944
Cr (mg/dL)	9.5 ± 2.2	11.9 ± 2.3	0.001
Sodium (mEq/L)	137.9 ± 2.8	136.7 ± 3.2	0.192
Potassium (mEq/L)	5.3 ± 0.7	4.4 ± 0.7	0.001
Calcium (mg/dL)	8.8 ± 0.5	9.0 ± 0.5	0.233
Phosphorus (mg/dL)	5.1 ± 1.4	5.6 ± 1.2	0.161
Parathyroid hormone (pg/mL)	191.2 ± 199.7	389.1 ± 311.6	0.005
Albumin (g/dL)	3.9 ± 0.3	3.4 ± 0.3	0.001

GNRI: Geriatric Nutritional Risk Index; OPNI: Onodera’s prognostic nutritional index; Kt/V: Dialysis adequacy; TLCs: Total lymphocyte counts; NA: Not Applicable; TIBC: Total iron binding capacity; TAST: transferrin saturation.

Table 2.

Clinical characteristics of 66 dialysis patients according to methods of dialysis after 3 month

Variables	HD (n=50)	PD (n=16)	Pvalue
Age	55.8 ± 12.7	49.8 ± 14.5	0.127
Sex (Male/Female)	28/22	10/6	0.774
DM	18 (36%)	7 (43.8%)	0.768
Duration of dialysis (months)	61.4 ± 50.9	69.1 ± 30.2	0.653
Body Mass Index	21.1 ± 2.5	23.8 ± 4.1	0.032
GNRI	99.5 ± 7.7	96.2 ± 9.2	0.184
OPNI	46.1 ± 4.5	38.4 ± 5.6	0.035
Systolic blood pressure (mmHg)	138.0 ± 31.4	133.7 ± 24.1	0.568
Diastolic blood pressure (mmHg)	80.6 ± 16.6	80.8 ± 11.8	0.972
Kt/V	1.76 ± 0.25	1.86 ± 0.37	0.263
Urea Reduction Rate (%)	76.0 ± 4.9	NA	NA
Neutrophil Lymphocyte Ratio	0.43 ± 0.15	0.60 ± 0.22	0.139
TLCs (/㎣)	1520 ± 526	1386 ± 697	0.570
CD3 count (/㎣)	1023 ± 428	905 ± 464	0.365
CD4 count (/㎣)	644 ± 296	627 ± 281	0.845
CD8 count (/㎣)	372 ± 169	380 ± 181	0.881
CD19 count (/㎣)	125 ± 81	112 ± 63	0.541
CD4/CD8 ratio	1.8 ± 0.7	0.7 ± 0.6	0.638

GNRI: Geriatric Nutritional Risk Index; OPNI: Onodera’s prognostic nutritional index; Kt/V: Dialysis adequacy; TLCs: Total lymphocyte counts; NA: Not Applicable

Table 3.

Clinical characteristics of 66 dialysis patients according to GNRI at start of the study

Variables	GNRI ≥ 100(n=33)	GNRI < 100 (n=33)	Pvalue
Age	54.0 ± 14.5	54.6 ± 12.4	0.860
Sex (Male/Female)	22/11	15/17	0.136
DM	11 (33.3%)	13 (40.6%)	0.612
HD/PD	27/6	24/9	0.389
Duration of dialysis (months)	47.1 ± 35.6	77.4 ± 55.9	0.011
Body Mass Index	23.8 ± 2.8	20.0 ± 2.1	0.001
GNRI	106.7 ± 3.4	92.9 ± 5.5	0.001
Systolic blood pressure (mmHg)	137.0 ± 20.9	137.2 ± 37.3	0.977
Diastolic blood pressure (mmHg)	81.2 ± 12.4	80.1 ± 18.5	0.788
Kt/V	1.7 ± 0.3	1.7 ± 0.2	0.576
Neutrophil Lymphocyte Ratio	0.43 ± 0.15	0.38 ± 0.11	0.226
TLCs (/㎣)	1530 ± 556	1555 ± 557	0.866
CD3 count (/㎣)	1093 ± 379	922 ± 387	0.076
CD4 count (/㎣)	672 ± 255	574 ± 245	0.118
CD8 count (/㎣)	420 ± 172	342 ± 162	0.065
CD19 count (/㎣)	146 ± 82	114 ± 85	0.123
CD4/CD8 ratio	1.7 ± 0.7	1.8 ± 0.7	0.612

GNRI: Geriatric Nutritional Risk Index; OPNI : Onodera’s prognostic nutritional index; Kt/V : Dialysis adequacy; TLCs : Total lymphocyte counts.

Table 4.

Clinical characteristics of 66 dialysis patients according to OPNI 45 at start of the study

Variables	OPNI ≥ 45 (n=46)	OPNI < 45 (n=20)	Pvalue
Age	53.2 ± 14.0	59.3 ± 10.5	0.080
Sex (Male/Female)	25/21	13/7	0.768
DM	18 (39.1%)	7 (35.3%)	0.988
HD/PD	39/7	11/9	0.002
Duration of dialysis (months)	50.8 ± 38.6	89.0 ± 66.8	0.009
Body Mass Index	21.7 ± 2.6	21.9 ± 3.3	0.797
OPNI	49.0 ± 2.6	39.7 ± 3.6	0.001
Systolic blood pressure (mmHg)	139.9 ± 25.5	133.5 ± 44.1	0.492
Diastolic blood pressure (mmHg)	80.2 ± 12.2	80.1 ± 24.3	0.986
Kt/V	1.7 ± 0.2	1.6 ± 0.2	0.476
Neutrophil Lymphocyte Ratio	0.38 ± 0.10	0.48 ± 0.18	0.011
TLCs (/㎣)	1710 ± 475	1164 ± 552	0.001
CD3 count (/㎣)	1085 ± 419	863 ± 353	0.049
CD4 count (/㎣)	677 ± 268	524 ± 222	0.034
CD8 count (/㎣)	411 ± 181	326 ± 160	0.089
CD19 count (/㎣)	141 ± 77	96 ± 89	0.061
CD4/CD8 ratio	1.8 ± 0.7	1.7 ± 0.7	0.851

GNRI : Geriatric Nutritional Risk Index; OPNI : Onodera’s prognostic nutritional index; Kt/V : Dialysis adequacy; TLCs : Total lymphocyte counts.

Table 5.

Logistic regression for predicting malnutrition according to GNRI 100 at start of the study

Variables	OR (95% CI)	Pvalue
Age > 60 years	10.783(1.936−60.059)	0.007
Female	2.115(0.752−9.194)	0.255
PD	3.159(0.338−29.533)	0.313
Duration of dialysis (months) > 60	0.705(0.136−3.657)	0.677
DM	1.507(0.342−6.633)	0.588
Total Lymphocyte Counts (/㎣) < 1500	0.473(0.113−1.972)	0.304
CD3 count (/㎣) < 1000	0.598(0.040−8.996)	0.711
CD4 count (/㎣) < 600	0.969(0.176−5.329)	0.971
CD8 count (/㎣) < 350	3.509(0.331−37.193)	0.297
CD19 count (/㎣) < 100	9.202(1.481−57.191)	0.017

Table 6.

Logistic regression for predicting malnutrition according to OPNI 45 at start of study

Variables	OR (95% CI)	Pvalue
Age > 60 years	6.724(1.450−19.884)	0.024
Female	1.115(0.152−8.194)	0.915
PD	5.307(1.872−14.457)	0.021
Duration of dialysis (months) > 60	2.467(0.326−18.672)	0.382
DM	0.541(0.053−5.473)	0.603
Total Lymphocyte Counts (/㎣) < 1500	4.351(0.698−27.121)	0.115
CD3 count (/㎣) < 1000	8.041(0.158−40.833)	0.298
CD4 count (/㎣) < 600	0.771(0.076−7.833)	0.826
CD8 count (/㎣) < 350	0.317(0.010−10.081)	0.515
CD19 count (/㎣) < 100	3.444(0.367−32.347)	0.279

Table 7.

Clinical characteristics of 66 dialysis patients according to CD19 count at start of the study

Variables	CD19 ≥ 100 (n = 41)	CD19 < 100 (n = 25)	Pvalue
Age	55.1 ± 13.7	53.1 ± 12.7	0.565
Sex (Male/Female)	21/20	17/8	0.208
DM	15 (36.6%)	10 (40%)	0.799
HD/PD	32/9	18/7	0.768
Duration of dialysis (months)	50.6 ± 37.7	78.8 ± 59.6	0.022
Body Mass Index	21.4 ± 2.9	22.3 ± 3.5	0.511
GNRI	101.2 ± 8.0	97.9 ± 8.4	0.121
OPNI	47.2 ± 5.1	44.4 ± 4.8	0.045
Systolic blood pressure (mmHg)	131.8 ± 30.6	145.4 ± 26.5	0.062
Diastolic blood pressure (mmHg)	78.2 ± 17.6	84.7 ± 10.2	0.065
Kt/V	1.74 ± 0.29	1.70 ± 0.22	0.504
Neutrophil Lymphocyte Ratio	0.42 ± 0.15	0.41 ± 0.15	0.931
TLCs (/㎣)	1525 ± 586	1537 ± 513	0.933
CD3 count (/㎣)	1129 ± 406	796 ± 256	0.001
CD4 count (/㎣)	701 ± 262	488 ± 169	0.001
CD8 count (/㎣)	426 ± 177	302 ± 127	0.002
CD19 count (/㎣)	176 ± 74	57 ± 26	0.001
CD4/CD8 ratio	1.7 ± 0.7	1.7 ± 0.7	0.905

GNRI : Geriatric Nutritional Risk Index; OPNI : Onodera’s prognostic nutritional index; Kt/V : Dialysis adequacy; TLCs : Total lymphocyte counts

Table 8.

Total lymphocyte count by several variables

Variables	Baseline	3 months	Pvalue*
Age
Age ≥ 60 years (n = 28)	1615 ± 535	1606 ± 550	0.193
Age < 60 years (n = 38)	1470 ± 550	1421 ± 474	0.193
Pvalue⁺	0.472	0.621
Sex
Male (n = 38)	1588 ± 563	1558 ± 593	0.547
Female (n = 28)	1506 ± 518	1486 ± 401	0.547
Pvalue⁺	0.533	0.891
Dialysis
Hemodialysis (n = 50)	1597 ± 512	1514 ± 522	0.433
Peritoneal Dialysis (n = 16)	1417 ± 625	1569 ± 520	0.433
Pvalue⁺	0.009	0.009
Duration of dialysis
Duration ≥ 60 months (n = 30)	1464 ± 551	1450 ± 508	0.223
Duration < 60 months (n = 36)	1628 ± 530	1592 ± 525	0.223
Pvalue⁺	0.043	0.043
DM
Yes (n = 25)	1587 ± 495	1508 ± 501	0.372
No (n = 41)	1533 ± 574	1539 ± 534	0.372
Pvalue⁺	0.292	0.292

^* P-values by treatment period obtained from linear model using repeated measured ANOVA

⁺ P-values by content obtained from linear model using repeated measured ANOVA

Table 9.

CD19 count by several variables

Variables	Baseline	3 months	Pvalue*
Age
Age ≥ 60 years (n = 28)	135 ± 93	126 ± 80	0.206
Age < 60 years (n = 38)	128 ± 77	118 ± 73	0.206
Pvalue⁺	0.709	0.709
Sex
Male (n = 38)	114 ± 63	111 ± 66	0.146
Female (n = 28)	154 ± 103	135 ± 87	0.146
Pvalue⁺	0.043	0.043
Dialysis
Hemodialysis (n = 50)	132 ± 85	124 ± 80	0.179
Peritoneal Dialysis (n = 16)	127 ± 84	111 ± 61	0.179
Pvalue⁺	0.666	0.666
Duration of dialysis
Duration ≥ 60 months (n = 30)	106 ± 78	94 ± 55	0.190
Duration < 60 months (n = 36)	152 ± 78	144 ± 84	0.190
Pvalue⁺	0.009	0.009
DM
Yes (n = 25)	118 ± 68	116 ± 61	0.294
No (n = 41)	139 ± 92	124 ± 84	0.294
Pvalue⁺	0.449	0.449

^* P-values by treatment period obtained from linear model using repeated measured ANOVA

⁺ P-values by content obtained from linear model using repeated measured ANOVA

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