The Association of Neutrophil Lymphocyte Ratio and Glycemic Markers in Hemodialysis Patients
Abstract
Background/aims: Neutrophil lymphocyte ratio was found to be as an inflammation marker in the preceding decade and recently related with glycemic indices in patients with diabetes mellitus. The target of this research was to explore the association of neutrophil lymphocyte ratio and glycemic indices in hemodialysis population. Methods: 177 hemodialysis patients (98 diabetic and 79 non-diabetic) aged 56.08±16.06 years were enrolled in this research. Neutrophil lymphocyte ratio was calculated and its association with predialysis glucose and HbA1c was studied. Results: NLR was positively correlated with predialysis glucose (p=0.000, r=0.338), body mass index (p=0.029, r=0.220), white blood cell (p=0.000, r=0.430), platelet (p=0.034, r=0.159), neutrophil (p=0.000, r=0.656) and C-reactive protein (p=0.00, r=0.377) levels. In non-diabetic hemodialysis group, predialysis glucose was still correlated with neutrophil lymphocyte ratio (p=0.047, r=0.224). Diabetics had higher predialysis glucose (185.94±81.11 vs 111.24±25.59, p=0.000) and neutrophil lymphocyte ratio (4.99±4.17 vs 2.82±1.23, p=0.000) compared to non-diabetics. Conclusion: This study revealed that predialysis glucose levels in hemodialysis patients are correlated with neutrophil lymphocyte ratio and hemodialysis patients with diabetes have higher neutrophil lymphocyte ratio levels. Neutrophil lymphocyte ratio should be recognized as a glycemic control marker along with traditional glycemic indices in HD patients.
Keywords
Diabetes Mellitus, HbA1c, Hemodialysis, Neutrophil Lymphocyte Ratio, Glucose
References
- Mehdi U, Toto RD. Anemia, diabetes, and chronic kidney disease. Diabetes Care 2009 Jul;32,7:1320-6. doi: 10.2337/dc08-0779.
- Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int 2020 Oct;98,4S:S1-S115. doi: 10.1016/j.kint.2020.06.019.
- American Diabetes Association Professional Practice Committee; American Diabetes Association Professional Practice Committee:, Draznin B, Aroda VR, Bakris G, Benson G, Brown FM, Freeman R, et al. 6. Glycemic Targets: Standards of Medical Care in Diabetes-2022. Diabetes Care 2022 Jan 1;45,Supplement_1:S83-S96. doi: 10.2337/dc22-S006.
- Copur S, Onal EM, Afsar B, Ortiz A, van Raalte DH, Cherney DZ, et al. Diabetes mellitus in chronic kidney disease: Biomarkers beyond HbA1c to estimate glycemic control and diabetes-dependent morbidity and mortality. J Diabetes Complications 2020 Nov;34,11:107707. doi: 10.1016/j.jdiacomp.2020.107707.
- Huang Z, Fu Z, Huang W, Huang K. Prognostic value of neutrophil-to-lymphocyte ratio in sepsis: A meta-analysis. Am J Emerg Med 2020 Mar;38,3:641-7. doi: 10.1016/j.ajem.2019.10.023.
- Yilmaz H, Bozkurt A, Cakmak M, Celik HT, Bilgic MA, Bavbek N, et al. Relationship between late arteriovenous fistula (AVF) stenosis and neutrophil-lymphocyte ratio (NLR) in chronic hemodialysis patients. Ren Fail 2014 Oct;36,9:1390-4. doi: 10.3109/0886022X.2014.945183.
- Zhu X, Li G, Li S, Gong Z, Liu J, Song S. Neutrophil-to-lymphocyte ratio and red blood cell distribution width-to-platelet ratio predict cardiovascular events in hemodialysis patients. Exp Ther Med 2020 Aug;20,2:1105-1114. doi: 10.3892/etm.2020.8756.
- Diaz-Martinez J, Campa A, Delgado-Enciso I, Hain D, George F, Huffman F, et al. The relationship of blood neutrophil-to-lymphocyte ratio with nutrition markers and health outcomes in hemodialysis patients. Int Urol Nephrol 2019 Jul;51,7:1239-1247. doi: 10.1007/s11255-019-02166-6.
- 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;46,5:408-416. doi: 10.1159/000484177.
- Mertoglu C, Gunay M. Neutrophil-Lymphocyte ratio and Platelet-Lymphocyte ratio as useful predictive markers of prediabetes and diabetes mellitus. Diabetes Metab Syndr 2017 Nov;11 Suppl 1:S127-S131. doi: 10.1016/j.dsx.2016.12.021.