Clinical significance of neutrophil-lymphocyte ratio in maintenance hemodialysis patients

Abstract

Objective To explore how neutrophil-lymphocyte ratio (NLR) is related with inflammation and atherosclerosis, and the role of NLR in hospitalization in maintenance hemodialysis (MHD) patients. Methods MHD patients treated in hemodialysis center of Sichuan Provincial People's Hospital from June till November 2013 were enrolled. Patients with severe infection, cardiovascular events and malignant carcinoma were excluded. NLR was determined from complete blood count differential. Clinical parameters such as serum albumin, lipids, intact parathormone, ferritin, C-reactive protein (CRP), 25-(OH) vitamin D, interleukin-6 (IL-6) and alkaline phosphatase (ALP) were collected. Pulse wave velocity (PWV) and ankle-brachial index (ABI) were used to evaluate the arterial stiffness. Spearman analysis was used to evaluate the relationship between NLR and these parameters. All patients were divided into low NLR group (NLR≤3.25) and high NLR group (NLR > 3.25) on the median NLR, and their differences in these indexes were analyzed. During the one-year follow-up, the reasons and rates of hospitalization and survival were analyzed. Results One hundred and thirteen MHD patients including 58 males and 55 females were enrolled with (69±49) dialysis age and (54±15) average age. (1) The NLR was significantly correlated with whole blood count (WBC, r= 0.538, P <0.001), ABIL (r=0.201, P=0.033), ABIR (r=0.235, P=0.012) and total cholesterol (TC, r=-0.414, P <0.001) and low-density lipoprotein cholesterol (LDL-C, r=-0.378, P <0.001). (2) Low NLR patients had increased TC, LDL-C and IL-6 as compare with high NLR patients, however decreased ABIL and ABIR (all P <0.05). (3) Forty one patients were hospitalized 63 times during the follow-up period. Annual hospitalization rate was 558/1000 and the mortality rate was 17.7/1000. (4) NLR in patients at least hospitalized once a year was significantly lower than in patients without hospitalization, while ALP was higher (all P <0.05). Compared with those in other patients, NLR and hemoglobin (Hb) were significantly lower in patients with hospitalization due to infection, while ALP was higher (all P <0.05). Conclusions NLR is related with WBC, ABI, TC and LDL-C in MHD patients. Lower NLR may indicate high risk for cardiovascular, atherosclerosis and hospitalization, probably different form non-MHD patients, which needs more studies to verify. Key words: Renal dialysis; Hospitalization; Neutrophil-lymphocyte ratio