Hematological indices derived from complete blood count and unfavorable outcomes in patients under-going peritoneal dialysis

Alves, Taluane Vívian Gomes; Giarola, Luciane Teixeira Passos; Oliveira Júnior, Wander Valadares de; Rios, Danyelle Romana Alves

doi:10.1590/2175-8239-JBN-2025-0017en

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ORIGINAL ARTICLE • Braz. J. Nephrol. 47 (4) • Oct-Dec 2025 • https://doi.org/10.1590/2175-8239-JBN-2025-0017en linkcopy

Hematological indices derived from complete blood count and unfavorable outcomes in patients under-going peritoneal dialysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction: Understanding the inflammatory processes that are associated with the risk of mortality in patients undergoing peritoneal dialysis (PD) may help guide clinical decision-making and risk and mortality stratification in this population.

Objective: To evaluate the association of hematological indices derived from complete blood count with unfavorable outcomes in patients undergoing PD.

Methods: Prospective cohort with 43 patients undergoing PD follow up for 18 months. Complete blood count data were collected from medical records and the hematological indices were calculated for all participants in the four follow-up waves. Associations between these indices and classic inflammatory markers were investigated by correlation analyses. Patient survival was estimated by the Kaplan Meier method (K-M) after dividing the patients into two groups based on the median as the cut-off point for each hematological index. The Cox model with competitive-risk framework was used to evaluate the influence of indices on survival.

Results: The AISI and SIRI indices had a significant positive correlation with global leukocytes (r = 0.74 and r = 0.71, respectively, p < 0.001). Only AISI and SII showed K-M significant estimates indicating greater survival for AISI ≤149.61 and SII ≤722.80. In the Cox regression model, patients who presented AISI above 149.6 and SII above 722.80 had 9.38 and 4.0 times, respectively, higher risk of death or transfer to HD than other patients.

Conclusion: AISI and SII were independently associated with the risk of unfavorable outcomes in PD patients.

Keywords:
Biomarkers; Peritoneal Dialysis; Mortality; Cox Models

Variables	Total	Reference values
Age (Years)	63.0 ± 15.3
Sex
Male [n (%)]	22 (51.2%)
BMI (kg/m²)	24.6 (21.3; 26.3)
Primary causes of CKD [n (%)]
Diabetes	13 (30.3%)
Systemic arterial hypertension	7 (16.3%)
CGN	2 (4.6%)
PKD, CAKUT	3 (7%)
Unknown aetiologies	18 (41.8%)
Systolic pressure (mmHg)	142.0 ± 21.4
Diastolic pressure (mmHg)	80 (80; 80)
Total patients with peritonitis recorded (n) in 18 months [n (%)]
0 peritonitis	28 (65.1%)
1 peritonitis	12 (57.1%)
2 peritonitis	1 (4,8)
3 peritonitis	1 (4.8%)
4 peritonitis	1 (4.8%)
Patients with peritonitis [n (%)]	15 (34.9%)
Total time on PD (months)	46.4 (31.0; 62.7)
HD before PD [n (%)]	10 (23.3%)
Time on HD or PD therapy (months)	45.8 ± 20.3
Time participating in the study (months)	16.4 ± 4.1
Deaths [n (%)]	10 (23.3%)
Time to death (months)	12.5 ± 4.2
Transferred to HD [n (%)]	6 (13.9%)
Has been on PD for over 36 months [n (%)]	17 (39.5%)
Fasting blood glucose (mg/dL)	102 (82; 146)	Less than 99 mg/dL
Serum creatinine (mg/dL)	9.47 ± 4.26	M: 1 (0.7 to 1.2 mg/dL) W: 0.8 (0.5 to 1.0 mg/dL)
Serum iron (mcg/dL)	64.88 ± 26.3	M: 65 mcg/dL to 175 mcg/dL W: 50 mcg/dL to 170 mcg/dL
Total iron binding capacity (mcg/dL)	209 (189; 253)	M: 69 mcg/dL to 240 mcg/dL W: 70 mcg/dL to 310 mcg/dL
Transferrin saturation index (%)	27.6 ± 13.3	20.0 to 55.0%
Ferritin (ng/mL)	169 (100; 482)	M: 23 to 336 ng/mL W: 12 to 306 NG/mL
Total cholesterol (mg/dL)	188.9 ± 66.0	< 190 mg/dL
HDL-C (mg/dL)	40 (34; 48)	M: > 40 mg/dL W: > 50 mg/dL
LDL-C (mg/dL)	114.4 ± 53.9	<130 mg/dL
Triglycerides (mg/dL)	150 (110; 208)	<150 mg/dL
Alanine aminotransferase (U/L)	19 (17; 25)	M: < 45 U/L W: < 34 U/L
Alkaline phosphatase (U/L)	93 (79; 117)	40 U/L to 150 U/L
Total protein (g/dL)	6.1 ± 0.6	6.0 to 8.0 g/dL
Albumin (g/dL)	3.2 ± 0.4	3.5 g/dL to 5.2 g/dL
Globulin (g/dL)	2.9 ± 0.4	1.5 to 3.5 g/dL
Calcium (mg/dL)	9.3 ± 0.7	8.8 to 10.4 mg/dL
Phosphorus (mg/dL)	5 (4.1; 6.4)	M: 2.4 to 4.6 mg/dL W: 2.3 to 4.3 mg/dL
Potassium (mmol/L)	4.5 ± 0.8	3.5 to 5.0 mmol/L
Parathyroid hormone (pg/mL)	184 (68; 375)	12.0 pg/ml to 88.0 pg/ml
Hemoglobin (g/dL)	11.7 ± 1.9	M: 14.9 g/dL (13.0–16.9) W: 13.2 g/dL (11.5–14.9)
Global leukocyte (x 10⁹/L)	6.4 ± 2.5	4.0 to 10.0 x 10⁹/L
Neutrophils (x 10⁹/L)	4.4 ± 1.7	2.0 to 7.0 x 10⁹/L
Bands (x 10⁹/L)	0.2 (0;0)	0 to 1.2 x 10⁹/L
Monocytes (x 10⁹/L)	0.2 (0.2; 0.3)	0.2 to 1.2 x 10⁹/L
Basophils (x 10⁹/L)	0.6 (0;0)	0 to 0.22 x 10⁹/L
Lymphocytes (x 10⁹/L)	1.4 (1.2; 1.9)	1.0 a 3.0 x 10⁹/L
Platelets (x 10⁹/L)	219.9 ± 81.7	150 to 450 x 10⁹/L

Markers	Ferritin	Global leukocytes	IL-6	IL-10
NLR	–0.14	0.22	–0.14	–0.09
dNLR	–0.17	0.19	–0.10	0.01
PLR	–0.11	–0.32*	–0.07	0.10
MLR	–0.15	0.16	–0.18	0.07
AISI	–0.19	0.74*	–0.11	–0.07
SII	–0.17	0.45*	–0.15	–0.03
SIRI	–0.20	0.71*	–0.17	–0.10

Parameter	Estimate	Deviation	Wald Statistic	p value	HR	CI_95%(HR)
Total time in PD	–0.03	0.01	–2.20	0.03*	0.97	(0.953; 0.997)
Sex	0.01	0.54	0.01	0.99	1.01	(0.352; 2.880)
Age	0.08	0.03	2.56	0.01*	1.09	(1.020; 1.161)
HD before PD	–1.09	0.99	–1.11	0.27	0.34	(0.049; 2.324)
Number of peritonitis episodes	0.85	0.37	2.28	0.02*	2.34	(1.127; 4.842)
Creatinine	0.32	0.11	3.01	< 0.01*	1.38	(1.119; 1.702)
AISI	2.24	0.78	2.86	< 0.01*	9.38	(2.025; 43.420)

Parameter	Estimate	Deviation standard error	Wald statistic	p value	HR	IC_95%(HR)
Total time in PD	–0.01	0.01	–1.18	0.24	0.99	(0.971; 1.007)
Sex	–0.17	0.53	–0.32	0.75	0.84	(0.297; 2.394)
Age	0.03	0.02	1.26	0.21	1.03	(0.985; 1.072)
HD before DP	–0.25	0.72	–0.34	0.73	0.78	(0.190; 3.217)
Number of peritonitis episodes	0.59	0.29	2.01	0.04*	1.80	(1.015; 3.182)
SII	1.39	0.65	2.14	0.03*	4.01	(1.127; 14.276)

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[1] Abbreviations – BMI: body mass index; CKD: chronic kidney disease; CGN: chronic glomerulonephritis; PKD: polycystic kidney disease; CAKUT: congenital abnormalities of the kidneys and urinary tract; PD: peritoneal dialysis; HD: hemodialysis; HDL-C: high-density lipoprotein-cholesterol; LDL-C: low-density lipoprotein-cholesterol; W: women; M: men.

[2] Notes – The results are presented as mean and standard deviation for data with normal distribution, according to the Shapiro-Wilk test, and median (quartiles) for data with asymmetric distribution. Categorical variables are presented as proportions: n (%).