Keywords
Mortality
Neutrophil lymphocyte index
Dialysis
How to Cite
Abstract
Background: The neutrophil-lymphocyte ratio (NLI) is an easily accessible biomarker that reflects both systemic inflammation and endothelial dysfunction, and has been used in patients with cardiovascular disease, cancer, and chronic kidney disease (CKD).
Purpose: To determine the association of the NLI with mortality in patients with chronic kidney disease stage 5 (CKD-5), prevalent in hemodialysis, between the years 2015-2016, in a public Hospital.
Methods: Cohort, observational and analytical design, the sampling was non-probabilistic and by convenience. We evaluated 250 records of patients with CKD-5 in ambulatory hemodialysis for at least 3 months, which started hemodialysis at the Hospital Nacional Arzobispo Loayza (HNAL) between the years 2015-2016, then were referred to external dialysis centers and had subsequent follow-up in the nephrology service of the HNAL, the observation ended on December 31, 2019. Multiple regression using generalized linear models was used in the analysis. The exposure variable was INL (?3.5 and < 3.5) and the outcome variable was vital status at the end of the observation
Results: The median age was 65 years with interquartile range (IQR) from 57 to 71, the percentage of deceased was 24% and the median observation time was 3.8 years IQR (2.8 - 3.9). In multivariate analysis, patients with NLI ? 3.5 had higher mortality (RR: 2.85, 95%CI: 2.17- 8.96, p = 0.033), adjusted for sex, age, neutrophil level, lymphocytes, platelets, C-reactive protein, ferritin, platelet-lymphocyte index, and Kt/V. The increase in 0.1 units of Kt/V was associated with a 9.7% decrease in mortality (95%CI: 0.02 - 0.08) p < 0. 001.
Conclusion: NLI ? 3.5 was associated with increased mortality in patients with CKD stage 5 on chronic hemodialysis.
References
Kidney Disease Improving Global Outcomes. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013;3(1).
Herrera-Añazco P, Benítes-Zapata VA, Hernandez AV. Factores asociados a mortalidad intrahospitalaria de una población en hemodiálisis en el Perú. Rev Perú Med Exp Salud Publica. 2015;32(3):479. https://doi.org/10.17843/rpmesp.2015.323.1677
Alvis-Peña D, Calderón-Franco C. Descripción de factores de riesgo para mortalidad en adultos con enfermedad renal crónica en estadio 3 - 5. Acta Méd Peru. 2020;37(2):163-8. http://dx.doi.org/10.35663/amp.2020.372.980
de Arriba G, Gutiérrez Avila G, Torres Guinea M, Moreno Alia I, Herruzo JA, Rincón Ruiz B, et al. La mortalidad de los pacientes en hemodiálisis está asociada con su situación clínica al comienzo del tratamiento. Nefrología. 2021;41(4):367-488. http://doi.org/10.1016/j.nefro.2020.11.006
Loaiza-Huallpa J, Condori-Huaraka M, Quispe-Rodríguez GH, Pinares-Valderrama MP, Cruz-Huanca AI, Atamari-Anahui N, et al. Mortalidad y factores asociados en pacientes con enfermedad renal crónica en hemodiálisis en un hospital peruano. Rev Haban Cienc Méd. 2019;18(1):164-75. http://www.revhabanera.sld.cu/index.php/rhab/article/view/2431/2209
Valga F, Monzón T, Henriquez F, Santana-del-Pino A, Antón-Pérez G. Índices plaquetas-linfocito y neutrófilo-linfocito como marcadores de resistencia a la eritropoyetina en pacientes en hemodiálisis crónica: estudio transversal-multicéntrico. Nefrología. 2020;40(3):213-370. http://doi.org/10.1016/j.nefro.2019.09.007
Neuen BL, Leather N, Greenwood AM, Gunnarsson R, Cho Y, Mantha ML. Neutrophil-lymphocyte ratio predicts cardiovascular and all-cause mortality in hemodialysis patients. Ren Fail. 2016;38(1):70-6. https://doi.org/10.3109/0886022x.2015.1104990
Alacapa LF, Yu MGY, Sandoval MAS. Association of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio with diabetic kidney disease among adult patients with type 2 Diabetes Mellitus: a meta-analysis of observational studies. Acta Med Philipp. 2022;56(5). https://doi.org/10.47895/amp.vi0.3217
Uduagbamen PK, Oyelese AT, Israel MG, Ajani Alalade B, Ahmed SI, Ogunmola MI, et al. The gender associations of neutrophil lymphocyte ratio in acute kidney injury and chronic kidney disease. J Adv Med Med Res. 2022;34(3):45-56. https://doi.org/10.9734/jammr/2022/v34i331272
Woziwodzka K, Dziewierz A, Pawica M, Panek A, Krzanowski M, Go?asa P, et al. Neutrophil-to-lymphocyte ratio predicts long-term all-cause mortality in patients with chronic kidney disease stage 5. Folia Med Cracov. 2019;59(4):55-70. https://doi.org/10.24425/fmc.2019.131380
Zhang J, Lu X, Wang S, Li H. High neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are associated with poor survival in patients with hemodialysis. Biomed Res Int. 2021;2021:9958081. https://doi.org/10.1155/2021/9958081
Catabay C, Obi Y, Streja E, Soohoo M, Park C, Rhee CM, et al. Lymphocyte cell ratios and mortality among incident hemodialysis patients. Am J Nephrol. 2017;46(5):408-16. https://doi.org/10.1159/000484177
Chávez Valencia V, Orizaga de la Cruz C, Mejía Rodríguez O, Gutiérrez Castellanos S, Lagunas Rangel FA, Viveros Sandoval ME. Inflammation in hemodialysis and their correlation with neutrophil-lymphocyte ratio and platelet- lymphocyte ratio. Nefrologia. 2017;37(5):554-6. https://doi.org/10.1016/j.nefro.2016.12.006
Tonyali S, Ceylan C, Yahsi S, Karakan MS. Does neutrophil to lymphocyte ratio demonstrate deterioration in renal function? Ren Fail. 2018;40(1):209-12. https://doi.org/10.1080/0886022X.2018.1455590
Yoshitomi R, Nakayama M, Sakoh T, Fukui A, Katafuchi E, Seki M, et al. High neutrophil/lymphocyte ratio is associated with poor renal outcomes in Japanese patients with chronic kidney disease. Ren Fail. 2019;41(1):238-43. https://doi.org/10.1080/0886022x.2019.1595645
Farag Allah MA, Seliem MF, Mabrouk MM, Abd El-Salam SA. Assessment of mean platelet volume and neutrophil/lymphocyte ratio in chronic kidney disease patients with proteinurea. Med J Cairo Univ. 2019;87(3):2191-9. https://doi.org/10.21608/mjcu.2019.54380
Brito GMC, Fontenele AMM, Carneiro ECRL, Nogueira IAL, Cavalcante TB, Vale AAM, et al. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in nondialysis chronic kidney patients. Int J Inflam. 2021;2021:6678960. https://doi.org/10.1155/2021/6678960
Uduagbamen PK, Oyelese AT, AdebolaYusuf AO, Thompson MU, Afeez Alalade BA, Ehioghae O. Neutrophil lymphocyte ratio as an inflammatory marker in chronic kidney disease: determinants and correlates. Open J Nephrol. 2022;12(01):23-35. https://doi.org/10.4236/ojneph.2022.121003
Kim J, Song SH, Oh TR, Suh SH, Choi HS, Kim CS, et al. Prognostic role of the neutrophil-to-lymphocyte ratio in patients with chronic kidney disease. Korean J Intern Med. 2023; 38:725?33. https://doi.org/10.3904/kjim.2023.171
Li P, Xia C, Liu P, Peng Z, Huang H, Wu J, et al. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in evaluation of inflammation in non-dialysis patients with end-stage renal disease (ESRD). BMC Nephrol. 2020;21(1):511. https://doi.org/10.1186/s12882-020-02174-0
Yaprak M, Turan MN, Dayanan R, Ak?n S, De?irmen E, Y?ld?r?m M, et al. Platelet-to-lymphocyte ratio predicts mortality better than neutrophil-to-lymphocyte ratio in hemodialysis patients. Int Urol Nephrol. 2016;48(8):1343-8. https://doi.org/10.1007/s11255-016-1301-4
Altunoren O, Akkus G, Sezal D, Ciftcioglu M, Guzel F, Isiktas S et al. Does neutrophyl to lymphocyte ratio really predict chronic kidney disease progression? Int Urol Nephrol. 2019;51:129-137. https://doi.org/10.1007/s11255-018-1994-7
Marques R, Carias EC, Domingos AT, Guedes AM, Bernardo I, Neves P. Prognostic value of lymphocyte cell ratios in peritoneal dialysis. Port J Nephrol Hypert. 2021;35(1):18-21. http://doi.org/10.32932/pjnh.2021.04.112
Loza C, Ramos W, Valencia M, Revilla L, López T, Tapia C, et al. Análisis de la situación de la enfermedad renal crónica en el Perú, 2015. Lima: Ministerio de Salud del Perú; 2016. 152 p. http://www.dge.gob.pe
Ghorbani M, Kia M, Razzaghi M. The association between platelet to lymphocyte ratio and neutrophil to lymphocyte ratio with inflammatory factors in hemodialysis patients. J Renal Inj Prev. 2022;11. https://doi.org/10.34172/jrip.2022.28846
Gan W, Guan Q, Hu X, Zeng X, Shao D, Xu L, et al. The association between platelet-lymphocyte ratio and the risk of all-cause mortality in chronic kidney disease: a systematic review and meta-analysis. Int Urol Nephrol. 2022;54(11):2959-67. https://doi.org/10.1007/s11255-022-03234-0
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