MON-293 NEUTROPHIL-LYMPHOCYTE RATIO IN PATIENTS WITH DIABETIC KIDNEY DISEASE

Abstract

A major complication of diabetes is diabetic kidney disease (DKD) which is currently the leading cause of end-stage renal disease worldwide. Furthermore, DKD has been shown to be an independent risk factor for cardiovascular disease morbidity and mortality. Hence, DKD places a huge burden on healthcare systems. Therefore, early detection of DKD is hoped to reduce morbidity and mortality and to improve patient quality of life. Considering the inflammatory pathways involved in the development of the DKD, markers of inflammation could be potentially used for detecting the disease at early stages. Given that the neutrophil-to-lymphocyte ratio (NLR) is a reliable measure of systemic inflammation, we hypothesized that higher NLR would be associated with an increased risk of having DKD with albuminuria. In a cross-sectional study, 535 patients with type 1 or type 2 diabetes attending Austin Health Diabetes Clinics were recruited. NLR was calculated by dividing the total neutrophil count by total lymphocyte count from a full blood examination. The Albumin excretion rate (AER) was calculated using urine albumin concentration, total urine volume and total collection time. Serum creatinine was run on the Roche Cobas C800 and then measured using the kinetic colorimetric assay based on the Jaffe method. Estimated glomerular filtration rate (eGFR) was calculated using the creatinine-based CKD-EPI equation. Multivariate logistic regression models adjusted for age, HbA1c, fasting cholesterol and CRP were run for the following three outcomes: 1) eGFR <60ml/min/1.73m2 and AER ≥20 µg/min, 2) eGFR <60ml/min/1.73m2 and AER <20 µg/min 3) eGFR <60ml/min/1.73m2. Analysis of 535 patients with a full set of observations for 1,202 visits (mean visit per patient =2.2) demonstrated that one unit increase in NLR was associated with 44% increased risk of having eGFR <60ml/min/1.73m2 along with an AER ≥20µg/min [ odds ratio (OR), 95% confidence interval (CI): 1.44 (1.01-2.05); p= 0.046]. However, there was no statistically significant association between NLR and having eGFR <60ml/min/1.73m2 and an AER <20µg/min [OR (95% CI): 0.87 (0.63-1.20); p=0.39] as well as having eGFR <60ml/min/1.73m2 alone [OR (95% CI): 0.75 (0.53-1.05); p= 0.096]. Higher NLR values are independently associated with stage 3-5 chronic kidney disease with albuminuria (AER≥20µg/min). These data support the potential association of inflammation in the development of diabetic kidney disease and support the need for future studies.