Higher Eosinophils Predict Death-Censored Technique Failure in Peritoneal Dialysis Patients

Abstract

Introduction:Eosinophilia (eosinophil fraction of leukocytes >5%), an indicative parameter for bioincompatibility in various circumstances, is well established in hemodialysis. However, change in eosinophil count (EOC) and its association with death-censored technique failure among peritoneal dialysis (PD) patients remain unclear.Methods:We compared eosinophils before and after PD initiation among 1,432 eligible continuous ambulatory PD patients regularly followed up in our PD center during 2007-2018. Risk factors of early-stage eosinophilia were examined by the logistic regression test. The relationship of early-stage eosinophilia and EOC with death-censored technique failure was examined using the Cox proportional hazards model for overall patients and for men and women separately.Results:After PD initiation, the EOC and percentage of patients with eosinophilia were significantly increased compared with baseline. Being male (odds ratio [OR]: 2.26; 95% confidence interval [CI]: 1.55-3.31;p< 0.001) and higher EOC at baseline (100 cells/mu L increase, OR: 1.62; 95% CI: 1.45-1.82;p< 0.001) were risk factors of early-stage eosinophilia after PD initiation. During follow-up, 204 death-censored technique failures were recorded. In fully adjusted models, each with 100 cells/mu L increase in EOC, the adjusted hazard ratios (HRs) of technique failure were 1.11 (95% CI: 1.03-1.20;p= 0.009) in the whole cohort, 1.29 (95% CI: 1.10-1.51;p= 0.002) in women, and 1.07 (95% CI: 0.97-1.17;p= 0.196) in men. Eosinophilia was significantly associated with the risk of technique failure for women (HR: 2.24; 95% CI: 1.07-4.70;p= 0.033), which was especially significant for women aged <55 years (HR: 7.61; 95% CI: 1.88-30.90;p= 0.005).Conclusion:EOC was increased significantly after PD initiation, and increased numbers of eosinophils were associated with higher death-censored technique failure in PD patients, especially women.