EVALUATION OF THE RELATIONSHIP BETWEEN NEUTROPHIL TO LYMPHOCYTE RATIO AND RENAL OUTCOMES PATIENTS WITH CHRONIC RENAL DISEASE

Year 2020, , 207 - 212, 25.06.2020

Edip Erkuş , Suleyman Karakose , Fatih Ergül Pervin Özkan İbrahim Güney

https://doi.org/10.16899/jcm.723339

Abstract

ABSTRACT
Aim: Regardless of the cause of renal disease, there is strong evidence that an acute and chronic proinflammatory condition exists in adults with chronic renal disease (CRD) and End Stage Renal Disease (ESRD) and that inflammation contributes to morbidity and mortality. In this study, we aimed to investigate whether neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are associated with poor renal outcome (ESRD + Death) in patients with CRD.
Materials and Methods: 194 Turkish CRD (stage 3-5) patients who were regularly came to the nephrology outpatient clinic were enrolled to study. patients records were evaluated and groupped according to the renal status and mortality at the end of four years follow up time.
Results: During the follow-up period, 15 out of 194 patients died, renal replacement treatment began to 89 patients and remaning 90 patients were still followed as non-ESRD patients. When compared the patients with ESRD and who were still followed up as non-ESRD patients there was a statistically significant difference in male gender, follow-up time, BMI, SBP, DBP, baseline eGFR, albumin, Hb, Ca, P, NLR, PLR and spot urine creatine ratio.NLR was as an independent risk factor in CRD patients for the progression of the disease and the poor renal outcome.
Conclusion: In conclusion, we demonstrated that NLR is an independent predictor of ESRD and poor renal outcome in CRD patients. Therefore, NLR measurement may be useful in predicting the progression of kidney disease in CRD patients.
Keywords: Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, chronic renal disease, progression

ÖZET
Amaç: Böbrek hastalığının nedenine bakılmaksızın, kronik böbrek hastalığı (KBH) ve Son Evre Böbrek Hastalığı (SDBY) olan yetişkinlerde akut ve kronik proinflamatuar bir durumun var olduğuna ve inflamasyonun morbidite ve mortaliteye katkıda bulunduğuna dair güçlü kanıtlar vardır. Bu çalışmada, CRD hastalarında nötrofil / lenfosit oranının (NLR) ve trombosit / lenfosit oranının (PLR) kötü böbrek sonucu (ESRD + Ölüm) ile ilişkili olup olmadığını araştırmayı amaçladık.
Gereç ve yöntem: Nefroloji polikliniğine düzenli olarak başvuran 194 Türk CRD (evre 3-5) çalışmaya alındı. Dört yıllık izlem süresi sonunda hasta kayıtları böbrek durumuna ve mortaliteye göre değerlendirildi.
Bulgular: Takip süresi boyunca 194 hastadan 15'i öldü, 89 hastaya renal replasman tedavisi başlandı ve 90 hasta halen ESRD olmayan hastalar olarak takip edilmektedir. ESRD olan hastalar ESRD olmayan hastalar ile karşılaştırıldığında erkek cinsiyet, takip süresi, BMI, SBP, DBP, başlangıç eGFR, albümin, Hb, Ca, P, NLR, PLR ve spot idrar kreatin oranı arasında istatistiksel olarak anlamlı bir fark vardı. NLR, CRD hastalarında hastalığın ilerlemesi ve kötü böbrek sonucu için bağımsız bir risk faktörü olarak bulundu.
Sonuç: Sonuç olarak, NLR'nin CRD hastalarında bağımsız bir ESRD ve kötü böbrek sonucu öngörücüsü olduğunu gösterdik. Bu nedenle NLR ölçümü, CRD hastalarında böbrek hastalığının ilerlemesini tahmin etmede yararlı olabilir.
Anahtar Kelimeler: Nötrofil / lenfosit oranı, trombosit / lenfosit oranı, kronik böbrek hastalığı, progresyon

Keywords

Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, chronic renal disease, progresyon

Project Number

approval no: 48929119/774 / 28-05

References

• 1 Silverstein DM. Inflammation in chronic kidney disease: role in the progression of renal and cardiovascular disease. Pediatr Nephrol 2009:24:1445–1452 .
• 2 Yu HT. Progression of chronic renal failure. Arch Intern Med 2003:163:1417–1429 .
• 3 Jacobson HR. Chronic renal failure: pathophysiology. Lancet 1991:338:419–423.
• 4 Manabe I. Chronic Inflammation Links Cardiovascular, Metabolic and Renal Diseases. Circ J. 2011;75(12):2739-2748
• 5 Akchurin OM, Kaskel F. Update on inflammation in chronic kidney disease. Blood Purif 2015:39:84–92
• 6 Kalantar-Zadeh K. Inflammatory marker mania in chronic kidney disease: pentraxins at the crossroad of universal soldiers of inflammation. Clin J Am Soc Nephrol 2007:2:872
• 7 Hill PA, Lan HY, Nikolic-Paterson DJ, Atkins RC. ICAM-1 directs migration and localization of intersitial leukocytes in experimental glomerulonephritis. Kidney Int. 1994;45:32–42.
• 8 Lebleu VS, Sugimoto H, Miller CA, Gattone VH, Kalluri R. Lymphocytes are dispensable for glomerulonephritis but required for renal interstitial fibrosis in matrix defect-induced Alport renal disease. Lab Invest. 2008;88:284–292
• 9 Abbate M, Zoja C, Corna D, Capitanio M, Bertani T, Remuzzi G. In progressive nephropathies, overload of tubular cells with filtered proteins translates glomerular permeability dysfunction into cellular signals of interstitial inflammation. J AmSoc Nephrol. 1998;9:1213–1224
• 10 Akchurin OM, Kaskel F. Update on inflammation in chronic kidney disease. Blood Purif 2015:39:84–92
• 11 Gungor O, Unal HU, Guclu A, Gezer M, Eyileten T, Guzel FBet al. IL-33 and ST2 levels in chronic kidney disease: associations with inflammation, vascular abnormalities, cardiovascular events, and survival. PLoS ONE 2017:14(6):e0178939.
• 12 Kidney Disease Improving Global Outcomes (KDIGO) CKD Work Group (2013) KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Inter Suppl 3:1–150
• 13 Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Chronic Kidney Disease Epidemiology Collaboration Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006. Aug;145(4):247-254
• 14 Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the management of arterial hypertension: The task force for the management of arterial hypertension of the European society of hypertension (ESH) and of the European society of cardiology (ESC). Eur Heart J. 2007;28(12):1462–1536.
• 15 WHO STEPS. Section 3: guide to physical measurements (Step 2). Geneva. 2008. Disponı´vel em:http://www.who.int/chp/steps/ Part3_Section3.pdf [Acessado em 28 June 2011
• 16 Kocyigit I, Eroglu E, Unal A,Sipahioglu MH, Tokgoz B, Oymak O et al. Role of neutrophil/ lymphocyte ratio in prediction of disease progression in patients with stage-4 chronic kidney disease. J Nephrol. 2013;26:358–365
• 17 Klahr S, Schreiner G, Ichikawa I. The progression of renal disease. N Engl J Med. 1988;318:1657-1666
• 18 Heinzelmann M, Mercer-Jones MA, Passmore JC. Neutrophils and renal failure. Am J Kidney Dis. 1999;34:384-399
• 19 Weinstein JR, Anderson S. The aging kidney: physiological changes. Adv Chronic Kidney Dis. 2010;17(4):302-307.
• 20 Fried L, Solomon C, Shlipak M, Seliger S, Stehman-Breen C, Bleyer AJ, et al. Inflammatory and prothrombotic markers and the progression of renal disease in elderly individuals. J Am Soc Nephrol. 2004;15:3184–3191
• 21 Bash LD, Erlinger TP, Coresh J, Marsh-Manzi J, Folsom AR, Astor BC. Inflammation, hemostasis, and the risk of kidney function decline in the Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis. 2009;53:596-605
• 22 Tatar E, Mirili C, Isikyakar T, Yaprak M, Guvercin G, Ozay E, et al. The association of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio with clinical outcomes in geriatric patients with stage 3–5 chronic kidney disease. Acta Clin Belg 2016:71:221–226.
• 23 Ryota Yoshitomi, Masaru Nakayama, Teppei Sakoh, Akiko Fukui, Eisuke Katafuchi, Makiko Seki, et al. High neutrophil/lymphocyte ratio is associated with poor renal outcomes in Japanese patients with chronic kidney disease, Renal Failure2019:41:1, 238-243.
• 24 Orcun Altunoren,Gulsum Akkus,Didem Tutuncu Sezal,Muhammed Ciftcioglu,Fatma Betul Guzel, Songul Isiktas,et al.Does neutrophyl to lymphocyte ratio really predict chronic kidney disease progression? Int Urol Nephrol. 2019;51(1):129-137.
• 25 Wang X, Zhang G, Jiang X, et al. Neutrophil to lymphocyte ratio in relation to risk of all-cause mortality and cardiovascular events among patients undergoing angiography or cardiac revascularization: a meta-analysis of observational studies. Atherosclerosis. 2014;234:206–213.
• 26 Templeton AJ, McNamara MG, _Seruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106:dju124.
• 27 Kollerits B, Fliser D, Heid IM, Ritz E, Kronenberg F; MMKD Study Group. Gender-specific association of adiponectin as a predictor of progression of chronic kidney disease: the Mild to Moderate Kidney Disease Study. Kidney Int. 2007;71: 1279-1286.
• 28 Spanaus KS, Kronenberg F, Ritz E, et al. Mild-to-Moderate Kidney Disease Study Group. B-type natriuretic peptide concentrations predict the progression of nondiabetic chronic kidney disease: the Mild-to-Moderate Kidney Disease Study. Clin Chem. 2007;53:1264-1272
• 29 Fliser D, Kollerits B, Neyer U, et al. Fibroblast growth factor 23 (FGF23) predicts progression of chronic kidneydisease: the Mild to Moderate Kidney Disease (MMKD) Study. J Am Soc Nephrol. 2007;18:2600-2608
• 30 Fliser D, Kronenberg F, Kielstein JT, et al. Asymmetric dimethylarginine and progression of chronic kidney disease: the mild to moderate kidney disease study. J Am Soc Nephrol. 2005;16:2456-2461.
• 31 Boes E, Fliser D, Ritz E, et al. Apolipoprotein A-IV predicts progression of chronic kidney disease: the mild to moderate kidney disease study. J Am Soc Nephrol. 2006;17(2):528-536.