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      Older Age and High Serum Ferritin Levels Associated With the Risk of Chronic Cytopenia in Hemodialysis Patients

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          Leukopenia or thrombocytopenia is sometimes observed in end-stage renal disease (ESRD) patients, but the association between chronic leukopenia or thrombocytopenia and hemodialysis (HD) is still unclear. We aimed to investigate the incidence of chronic leukopenia or thrombocytopenia in patients with ESRD who received HD and to determine the risk factors of this complication. We retrospectively analyzed ESRD patients treated with HD at Ditmanson Medical Foundation Chia-Yi Christian Hospital in 2018. The risk factors for the occurrence of chronic leukopenia and thrombocytopenia were analyzed by Cox regression models. Of the 473 patients in our study cohort, 46 (9.7%) patients had a hematologic abnormality, including 18 patients with chronic leukopenia, 18 with chronic thrombocytopenia, and 10 with pancytopenia. Multivariate analysis revealed that patient age ≥60 years at the initiation of dialysis was a significant predictor for both chronic leukopenia [adjusted hazard ratio (aHR), 2.71; 95% confidence interval (CI), 1.06-6.89] and chronic thrombocytopenia (aHR, 2.83; 95% CI, 1.08–7.35). Chronic liver disease (aHR, 3.31; 95% CI, 1.27–8.61) and serum ferritin levels >800 mg/dl (aHR, 3.29; 95% CI, 1.29–8.39) were risk factors for chronic thrombocytopenia. A trend showed that vitamin D from intravenous supplementation (aHR, 0.13; 95% CI, 0.01–1.16, P = 0.066) and serum phosphorous level (aHR, 0.73; 95% CI, 0.53–1.02, P = 0.068) may be associated with chronic thrombocytopenia. Our study demonstrated that hematological abnormality was a long-term complication of HD. These results reveal that older patients with HD and high serum ferritin levels are at an elevated risk for chronic cytopenia. Healthcare professionals should be aware of this risk when treating HD patients in order to improve their prognosis.

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          Most cited references 49

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                Author and article information

                Front Med (Lausanne)
                Front Med (Lausanne)
                Front. Med.
                Frontiers in Medicine
                Frontiers Media S.A.
                29 October 2020
                : 7
                1Division of Hematology and Oncology, Department of Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital , Chiayi, Taiwan
                2Min-Hwei Junior College of Health Care Management , Tainan, Taiwan
                3Division of Nephrology, Department of Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital , Chiayi, Taiwan
                4Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science , Tainan, Taiwan
                5Department of Applied Life Science and Health, Chia Nan University of Pharmacy and Science , Tainan, Taiwan
                Author notes

                Edited by: Natalia Lopez-Andres, NavarraBiomed, Spain

                Reviewed by: Maria-Eleni Roumelioti, University of New Mexico, United States; Ashish K. Solanki, Medical University of South Carolina, United States

                *Correspondence: Peir-Haur Hung dtmedg3@

                This article was submitted to Nephrology, a section of the journal Frontiers in Medicine

                †These authors have contributed equally to this work

                Copyright © 2020 Lee, Wang, Kuo, Lee, Lu, Hsiao, Hsu and Hung.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                Page count
                Figures: 3, Tables: 2, Equations: 0, References: 49, Pages: 9, Words: 5167
                Original Research


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