Bone marrow pathology predicts mortality in chronic hemodialysis patients.

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 (P = 0.001), band and segmented cells (P = 0.021), and lymphoid cells (P = 0.029) 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, P = 0.001) and absent (OR 9.751, 95% CI 2.030-45.115, P = 0.004) megakaryocyte distribution (normal megakaryocyte distribution as the reference group), as well as myeloid/erythroid ratio (OR 1.054, CI 1.012-1.098, P = 0.011), 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.