The neutrophil-to-lymphocyte ratio may indicate when to start hemodialysis

Abstract

We evaluated whether the neutrophil-to-lymphocyte ratio (NLR) could aid dialysis decision-making in combination with the clinical presentation and biochemical findings. We retrospectively evaluated the medical records of 279 patients who commenced chronic maintenance hemodialysis. We compared the laboratory findings at 6 months before dialysis to those at dialysis initiation. NLR cutoffs and risk factors for each of six uremic symptoms were determined. Mean age was 60.7 years and mean estimated glomerular filtration rate (eGFR) was 5.7 ± 2.5 mL/min/1.73 m 2 at the time of hemodialysis and 7.7 ± 3.8 mL/min/1.73 m 2 6 months earlier ( p < 0.001). The mean NLR increased significantly from 2.5 ± 1.0 to 4.9 ± 2.8 ( p < 0.001). The NLR was positively correlated with the C-reactive protein level ( r = 0.202, p = 0.009) and negatively correlated with those of albumin ( r = −0.192, p = 0.001) and total CO 2 ( r = −0.134, p = 0.023). The NLR cutoffs for neurological and gastrointestinal symptoms as determined using receiver operator curve analysis were 2.4 (area under the curve [AUC] 0.976; 95% confidence interval [CI] 0.960–0.993; sensitivity 92.2%; specificity 94.7%) and 3.6 (AUC 0.671; 95% CI 0.588–0.755; sensitivity 68.1%; specificity 63.5%), respectively. On multiple linear regression analysis of neurological symptoms, the NLR was a significant predictor ( β = −0.218, p = 0.017), as was age ( β = 0.314, p = 0.037). In conclusion, the NLR may serve as a supplementary marker predicting uremic symptoms and a need for hemodialysis in stage 5 CKD patients.

Prediction Model for Early-Stage CKD Using the Naples Prognostic Score and Plasma Indoleamine 2,3-dioxygenase Activity

“… 27 There is also evidence that the NLR could serve as a supplementary marker for predicting the onset of uremic symptoms and the need for hemodialysis in patients with CKD5. 28 Chen et al reported that an elevated NLR was associated with longer hospital stay and more dialysis sessions. 29 Other studies of hemodialysis patients concluded that the NLR was a predictor of mortality and cardiovascular events in hemodialysis patients.…”

Systemic Immune Inflammation Index as a Key Predictor of Dialysis in Pediatric Chronic Kidney Disease with the Use of Random Forest Classifier

“…Consequently, the neutrophil-to-lymphocyte ratio (NLR) was proposed as a supplementary marker of CKD progression and the need for starting hemodialysis [16,39,40]. Even in the patients with normal white blood cell count, higher NLR was associated with higher long-term all-cause mortality in CKD stage 5 [41].…”

Progress in the application of the neutrophil-to-lymphocyte ratio in dialysis-related complications

“…In addition, prior to HD initiation a higher NLR may be associated with the severity of chronic kidney disease and mineral bone disease. Therefore, the NLR can be used to predict uremic symptoms and the need for HD in patients with chronic kidney disease [ 53 ]. These results enhance our understanding of the association between the NLR and quality of life in individuals undergoing dialysis.…”