Abstract
Background: Several studies have shown that the neutrophil/lymphocyte ratio (NLR) is a marker that reflects the state of systemic inflammation. A high NLR was reported to be associated with cardiovascular events and mortality. However, little is known about the association between NLR and kidney disease progression in patients with chronic kidney disease (CKD). Therefore, the aim of the present study was to determine whether NLR is associated with renal outcomes in CKD patients.Methods: This prospective observational study included 350 consecutive patients with stage 1–4 CKD treated between June 2009 and November 2016. Data were collected until June 2017. The endpoint was the composite of end-stage renal disease requiring dialysis or death. Subjects were divided into two groups according to high and low NLR levels. A Cox proportional hazards model was used to determine the risk factors for composite outcomes.Results: The composite endpoint was observed in 83 patients during the median follow-up period of 31.8 months: 29 in the low NLR group and 54 in the high NLR group. Multivariable analysis showed that the high NLR group had a significant increase in the hazard ratio (HR) for composite outcomes (HR 1.67, 95% confidence interval 1.02–2.77) compared with the low NLR group.Conclusion: The present study demonstrated that a high NLR was associated with poor renal outcomes, suggesting that NLR may be a useful marker for prognostic prediction in patients with CKD.
Highlights
Chronic inflammation has an important role in the onset and progression of various diseases such as diabetes mellitus, cardiovascular disease, and chronic kidney disease (CKD) [1]
The present study demonstrated that the high neutrophil/lymphocyte ratio (NLR) group had a significantly increased risk for adverse renal outcomes, in contrast to the high neutrophil or low lymphocyte count groups, in patients with CKD stages 1–4, compared with each reference group
Multivariable linear regression analysis showed that NLR was correlated with Creactive protein (CRP), estimated glomerular filtration rate (eGFR), and the presence of ischemic heart disease (IHD)
Summary
Chronic inflammation has an important role in the onset and progression of various diseases such as diabetes mellitus, cardiovascular disease, and chronic kidney disease (CKD) [1]. Patients with CKD tend to have elevated levels of inflammatory mediators including Creactive protein (CRP), tumor necrosis factor-a (TNF-a), and interleukin (IL)-6 [2]. These mediators stimulate mesangial and endothelial glomerular cells and subsequently cause an increase in the production and a decrease in the degradation of the mesangial and endothelial extracellular matrix, leading to glomerular hypertension, tubulointerstitial fibrosis and renal scarring [3,4]. NLR in patients with CKD was reported to be associated with other inflammatory markers such as IL-6 or high sensitivity-CRP [10], as well as endothelial dysfunction and cardiovascular risk [11,12]. Conclusion: The present study demonstrated that a high NLR was associated with poor renal outcomes, suggesting that NLR may be a useful marker for prognostic prediction in patients with CKD
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