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BioMed Research International
Volume 2015, Article ID 160382, 7 pages
http://dx.doi.org/10.1155/2015/160382
Research Article

Bone Marrow Pathology Predicts Mortality in Chronic Hemodialysis Patients

1Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou 333, Taiwan
2College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
3Kidney Research Center, Chang Gung Memorial Hospital, Linkou 333, Taiwan
4Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital, Keelung 204, Taiwan
5Department of Nephrology, China Medical University Hospital, Taichung 404, Taiwan
6College of Medicine, China Medical University, Taichung 404, Taiwan
7Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou 333, Taiwan

Received 6 November 2014; Revised 10 January 2015; Accepted 9 February 2015

Academic Editor: Urszula Demkow

Copyright © 2015 Cheng-Hao Weng et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. A bone marrow biopsy is a useful procedure for the diagnosis and staging of various hematologic and systemic diseases. The objective of this study was to investigate whether the findings of bone marrow studies can predict mortality in chronic hemodialysis patients. Methods. Seventy-eight end-stage renal disease patients on maintenance hemodialysis underwent bone marrow biopsies between 2000 and 2011, with the most common indication being unexplained anemia followed by unexplained leukocytosis and leukopenia. Results. The survivors had a higher incidence of abnormal megakaryocyte distribution , band and segmented cells , and lymphoid cells than the nonsurvivors. The overall mortality rate was 38.5% (30/78), and the most common cause of mortality was sepsis (83.3%) followed by respiratory failure (10%). In multivariate Cox regression analysis, both decreased (OR 3.714, 95% CI 1.671–8.253, ) and absent (OR 9.751, 95% CI 2.030–45.115, ) megakaryocyte distribution (normal megakaryocyte distribution as the reference group), as well as myeloid/erythroid ratio (OR 1.054, CI 1.012–1.098, ), were predictive of mortality. Conclusion. The results of a bone marrow biopsy can be used to assess the pathology, and, in addition, myeloid/erythroid ratio and abnormal megakaryocyte distribution can predict mortality in chronic hemodialysis patients.