White blood cell fractions correlate with lesions of diabetic kidney disease and predict loss of kidney function in Type 2 diabetes. Issue 6 (18th July 2017)

• Record Type: Journal Article
• Authors: Wheelock, Kevin M; Saulnier, Pierre-Jean; Tanamas, Stephanie K; Vijayakumar, Pavithra; Weil, E Jennifer; Looker, Helen C; Hanson, Robert L; Lemley, Kevin V; Yee, Berne; Knowler, William C; Hadjadj, Samy; Najafian, Behzad; Mauer, Michael; Nelson, Robert G
• Is Part Of: Nephrology dialysis transplantation. Volume 33:Issue 6(2018)
• Page Start: 1001
• Page End: 1009
• Publication Date: 2017-07-18
• Subjects: biomarkers -- CKD -- diabetic kidney disease -- inflammation -- kidney biopsy; Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfx231
• Languages: English
• ISSNs: 0931-0509

Abstract

ABSTRACT: Background: Inflammation linked to diabetic kidney disease (DKD) may affect white blood cell (WBC) counts and differentials. We examined the cross-sectional associations of total WBC count and WBC fractions with structural lesions of DKD in 108 Pima Indians with Type 2 diabetes who underwent research kidney biopsies. We also examined the longitudinal association of these WBC variables with renal function loss (RFL) in 941 Europeans with Type 2 diabetes from the SURDIAGENE study. Methods: Associations of WBC variables with morphometric parameters were assessed by linear regression. RFL was defined as≥40% loss of estimated glomerular filtration rate from baseline. Associations with RFL were evaluated by Cox regression. Hazard ratios (HRs) were reported per standard deviation increment of each WBC variable. Results: After multivariable adjustment, lymphocyte ( r = −0.20, P = 0.043) and eosinophil ( r = 0.21, P = 0.032) fractions in the Pima Indians correlated with glomerular basement membrane width. Eosinophil fraction also correlated with glomerular filtration surface density ( r = −0.21, P = 0.031). Lymphocyte fraction ( r = 0.25, P = 0.013), neutrophil fraction ( r = −0.23, P = 0.021) and the neutrophil:lymphocyte ratio ( r = −0.22, P = 0.024) correlated with percentage of normally fenestrated endothelial cells. During median follow-up of 4.5 years, 321 SURDIAGENE participants developed RFL. Lower lymphocyte fraction [HR = 0.67, 95% confidence interval (95% CI) 0.60–0.76] and higher neutrophil fraction (HR = 1.35, 95% CI 1.20–1.52), total WBC count (HR = 1.20, 95% CI 1.08–1.35) and neutrophil:lymphocyte ratio (HR = 1.44, 95% CI 1.28–1.62) each predicted RFL in this cohort. Conclusions: WBC fractions associate with morphometric lesions of DKD and predict RFL in individuals with Type 2 diabetes.