Hemodiyaliz hastalarında hipertansiyon: inflamatuar, hematolojik ve biyokimyasal değişiklikler ile MPV ve MPVLR’nin klinik önemi

Abstract

Amaç: Hemodiyaliz, kalıcı inflamatuar yolakların aktivasyonu ile karakterizedir; bu durum immün disfonksiyon ve artmış kardiyovasküler morbidite ve mortaliteye yol açmaktadır. Hipertansiyon, bu hastalar arasında oldukça yaygındır ve giderek artan kanıtlar, sistemik inflamatuar ve immün mekanizmaların hipertansiyon gelişiminde rol oynadığını göstermektedir. Bu çalışma, hipertansiyonun hemodiyaliz hastalarında sistemik inflamatuar ve immün-inflamatuar indeksler ile hematolojik ve biyokimyasal parametreler üzerindeki etkisini değerlendirmeyi amaçlamıştır. Yöntemler: Bu retrospektif çok merkezli çalışma, hemodiyaliz uygulanan 223 hasta ile gerçekleştirilmiştir. Hastalar hipertansif (n=90) ve normotansif (n=133) gruplar olarak sınıflandırılmıştır. SII, SIRI, PIV, NLR, LMR, PLR ve MPVLR dahil olmak üzere sistemik immün-inflamatuar indeksler hesaplanmıştır. Hematolojik ve biyokimyasal parametreler kapsamlı bir şekilde analiz edilmiştir. Biyobelirteçlerin tanısal performansı, alıcı işletim karakteristikleri (ROC) eğrisi analizi ile değerlendirilmiştir. Bulgular: Hipertansif hemodiyaliz hastalarında, normotansif hastalara kıyasla MPVLR (p=0,033) ve MPV (p=0,039) anlamlı olarak yüksek bulunmuş; lenfosit sayısı (p=0,002), hematokrit (p=0,021) ve serum kalsiyum düzeyleri (p=0,021) ise düşük bulunmuştur. Cinsiyete göre yapılan analizlerde, kadınlarda SII, PIV, MPVLR ve lipid düzeyleri daha yüksek, sodyum ve ALT ise erkeklere göre daha düşük bulunmuştur (tüm p<0,05). ROC analizinde, hipertansif durumu ayırt etmede MPV yüksek özgüllük (%83,0), MPVLR ise yüksek duyarlılık (%78,9) göstermiştir. Korelasyon analizleri MPVLR’nin MPV, NLR ve PLR ile pozitif ilişkili olduğunu, SII’nin ise birçok inflamatuar belirteçle güçlü korelasyon gösterdiğini ortaya koymuştur. Sonuç: Hemodiyaliz hastalarında hipertansiyon, MPV ve MPVLR’nin yükselmesi ile lenfosit sayısı, hematokrit ve kalsiyum düzeylerinin azalmasıyla ilişkilidir; bu durum trombosit aktivasyonu, immün disfonksiyon ve metabolik dengesizliği işaret etmektedir. Bu parametreler, hipertansiyonun tanı ve yönetiminde kullanılabilecek erişilebilir ve maliyeti düşük biyobelirteçler olarak hizmet edebilir. Önemli olarak, cinsiyete bağlı farklılıklar, kişiselleştirilmiş tedavi yaklaşımlarının önemini vurgulamaktadır.

Keywords

• Hipertansiyon
• Hemodiyaliz
• immün-inflamatuar indeksler
• Hematolojik belirteçler
• Biyokimyasal belirteçler

Inflammatory indices in hypertensive hemodialysis patients: clinical implications of MPV and MPVLR

Abstract

Aims: Hemodialysis is marked by persistent activation of inflammatory pathways, leading to immune dysregulation and increased cardiovascular morbidity and mortality. Hypertension is highly prevalent among these patients, with growing evidence implicating systemic inflammation and immune mechanisms in its development. This study aimed to evaluate the influence of hypertension on systemic inflammatory and immune-inflammatory indices, as well as hematological and biochemical parameters, in hemodialysis. Methods: This retrospective multicenter study was conducted with 223 patients receiving hemodialysis. Patients were divided into hypertensive (n=90) and normotensive (n=133) groups. Systemic immune-inflammatory indices, including SII, SIRI, PIV, NLR, LMR, PLR, and MPVLR, were calculated. Hematological and biochemical parameters were comprehensively analyzed. Diagnostic performance of biomarkers was assessed using receiver operating characteristic (ROC) curve analysis. Results: Hypertensive hemodialysis patients showed significantly higher MPVLR (p=0.033) and MPV (p=0.039), along with reduced lymphocyte counts (p=0.002), hematocrit (p=0.021), and serum calcium levels (p=0.021) compared with normotensive patients. In sex-stratified analyses, females had higher SII, PIV, MPVLR, and lipid levels, while sodium and ALT were lower than in males (all p<0.05). ROC analysis demonstrated high specificity for MPV (83.0%) and high sensitivity for MPVLR (78.9%) in distinguishing hypertensive status. Correlation analysis revealed MPVLR was positively associated with MPV, NLR, and PLR, while SII strongly correlated with multiple inflammatory markers. Conclusion: Hypertension in hemodialysis patients is implicated in elevated MPV and MPVLR, along with reduced lymphocyte counts, hematocrit, and calcium levels, which may indicate platelet activation, immune dysregulation, and metabolic imbalance. These parameters may provide adjunctive and cost-effective information for risk stratification and the follow-up of systemic inflammation in this vulnerable patient group. Importantly, sex based variations highlight the importance of personalized treatment approaches.

Keywords

• Hypertension
• hemodialysis
• immune-inflammatory indices
• hematological markers
• biochemical marker

References

1. Campo S, Lacquaniti A, Trombetta D, Smeriglio A, Monardo P. Immune system dysfunction and inflammation in hemodialysis patients: two sides of the same coin. J Clin Med. 2022;11(13):3759. doi:10.3390/jcm 11133759
2. Ilyas D, Blackburn E, Herbert A, et al. The CompAct-HD trial reports a persistent inflammatory profile in patients undergoing haemodialysis, acutely exacerbated with each treatment. Nephrology Dialysis Transplantation. 2024;39(Supplement_1):gfae069-0159-2866. doi:10. 1093/ndt/gfae069.159
3. Zhu J, Shi R, Li X, et al. Association between neutrophil percentage-to-albumin ratio and mortality in hemodialysis patients: insights from a prospective cohort study. BMC Nephrol. 2025;26(1):112. doi:10.1186/s12882-025-04027-0
4. Dawood A, Fiedler R, Markau S, Girndt M, Ulrich C. Polysome profiling proves impaired IL-10 and Caspase-8 translation in PBMCs of hemodialysis patients. Biomolecules. 2025;15(3):335. doi:10.3390/biom 15030335
5. Xiang F, Sun L, Cao X, et al. CD73 as a T cell dysfunction marker predicting cardiovascular and infection events in patients undergoing hemodialysis. Clinica Chimica Acta. 2024;555:117791. doi:10.1016/j.cca. 2024.117791
6. Bucharles SGE, Wallbach KKS, Moraes TP de, Pecoits-Filho R. Hypertension in patients on dialysis: diagnosis, mechanisms, and management. J Bras Nefrol. 2019;41(3):400-411. doi:10.1590/2175-8239-jbn-2018-0155
7. Aydoğdu S, Güler K, Bayram F, et al. 2019 Turkish hypertension consensus report. Turk Kardiyol Dern Ars. 2019;47(6):535-546. doi:10. 5543/tkda.2019.62565
8. Muntner P, Carey RM, Gidding S, et al. Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. Circulation. 2018; 137(2):109-118. doi:10.1161/CIRCULATIONAHA.117.032582

9. Zhang Z, Zhao L, Zhou X, Meng X, Zhou X. Role of inflammation, immunity, and oxidative stress in hypertension: new insights and potential therapeutic targets. Front Immunol. 2023;13:1098725. doi:10. 3389/fimmu.2022.1098725
10. Guzik TJ, Nosalski R, Maffia P, Drummond GR. Immune and inflammatory mechanisms in hypertension. Nat Rev Cardiol. 2024;21(6): 396-416. doi:10.1038/s41569-023-00964-1
11. Caillon A, Paradis P, Schiffrin EL. Role of immune cells in hypertension. Br J Pharmacol. 2019;176(12):1818-1828. doi:10.1111/bph.14427
12. Nguyen BA, Alexander MR, Harrison DG. Immune mechanisms in the pathophysiology of hypertension. Nat Rev Nephrol. 2024;20(8):530-540. doi:10.1038/s41581-024-00838-w
13. Li YB, Li SK. Clinical value of mean platelet volume/lymphocyte ratio and degree of coronary artery disease in patients with chronic kidney disease. Linchuang Shenzangbing Zazhi. 2022;22:365-369.
14. Bilik MZ, Oylumlu M, Oylumlu M, et al. Novel predictor of pulmonary arterial hypertension: monocyte to HDL cholesterol ratio. Medicine. 2022;101(34):e29973. doi:10.1097/MD.0000000000029973
15. Han XX, Zhang HY, Kong JW, Liu YX, Zhang KR, Ren WY. Inflammatory index is a promising biomarker for maintenance hemodialysis patients with cardiovascular disease. Eur J Med Res. 2024;29(1):544. doi:10.1186/s40001-024-02117-7
16. Elangovan D. Association of NLR, MLR, PLR, SII, and SIRI with the stages of chronic kidney disease-a cross-sectional study. Int J Med Biochem. 2024;7(3):186-194. doi:10.14744/ijmb.2024.98150
17. Xu B, Zhang Y, Chen G, Feng J, Gan L. Association of mean platelet volume/lymphocyte ratio with inflammation in non-dialysis patients with chronic kidney disease stages 1-4: a retrospective study. Front Immunol. 2022;13:1041356. doi:10.3389/fimmu.2022.1041356
18. Soelistyoningsih D, Wira D, Qodir A, Rifa’i A. Mean platelet volume as potential predictor of intradialytic hypertension. Jurnal Profesi Medika: Jurnal Kedokteran dan Kesehatan. 2024;18(2):225-231. doi:10.33533/jpm.v18i2.9475
19. Fei Y, Wang X, Zhang H, Huang M, Chen X, Zhang C. Reference intervals of systemic immune-inflammation index, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, mean platelet volume to platelet ratio, mean platelet volume and red blood cell distribution width-standard deviation in healthy Han adults in Wuhan region in central China. Scand J Clin Lab Invest. 2020;80(6):500-507. doi:10.1080/ 00365513.2020.1793220
20. Pergola C, Rogge A, Dodt G, et al. Testosterone suppresses phospholipase D, causing sex differences in leukotriene biosynthesis in human monocytes. FASEB J. 2011;25(10):3377-3387. doi:10.1096/fj.11-182758
21. Wei C, Zhang W, Chen J, et al. Systematic analysis between inflammation-related index and sex hormones in American adults: cross-sectional research based NHANES 2013-2016. Front Immunol. 2023;14:1175764. doi:10.3389/fimmu.2023.1175764
22. Casimir GJ, Lefèvre N, Corazza F, Duchateau J. Sex and inflammation in respiratory diseases: a clinical viewpoint. Biol Sex Differ. 2013;4:16. doi:10.1186/2042-6410-4-16
23. Villa-Etchegoyen C, Lombarte M, Matamoros N, Belizán JM, Cormick G. Mechanisms involved in the relationship between low calcium intake and high blood pressure. Nutrients. 2019;11(5):1112. doi:10.3390/nu 11051112
24. Mora-Bravo FG, Torres PTM, Campoverde NR, et al. Blood pressure control with active ultrafiltration measures and without antihypertensives is essential for survival in hemodiafiltration and hemodialysis programs for patients with CKD: a prospective observational study. BMC Nephrology. 2025;26(1):30. doi:10.1186/s12882-025-03948-0
25. Tanic AS, Rinaldi FX, Polanit VL, Kalaij AGI. High neutrophil-to-lymphocyte ratio as a predictor of all-cause and cardiovascular-related mortality in hemodialysis patients: a systematic review and meta-analysis of cohort studies. Indian J Nephrol. 2024;0(0):1-9. doi:10.25259/IJN_470_2024
26. Castellana E, Budau PM, Chiappetta MR. Women and hyponatremia: an analysis of sex differences in adverse drug reactions. Hosp Pharm. 2025;60(4):309-313. doi:10.1177/00185787251337618
27. Hu R, McDonough AA, Layton AT. Sex differences in solute and water handling in the human kidney: modeling and functional implications. iScience. 2021;24(6):102667. doi:10.1016/j.isci.2021.102667
28. Jarin J, Pine-Twaddell E, Trotman G, et al. Cross-sex hormones and metabolic parameters in adolescents with gender dysphoria. Pediatrics. 2017;139(5):e20163173. doi:10.1542/peds.2016-3173