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Association of neutrophil-to-lymphocyte ratio and risk of cardiovascular or all-cause mortality in chronic kidney disease: a meta-analysis

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Abstract

Background

It is currently controversial whether neutrophil-to-lymphocyte ratio (NLR) has a prognostic role in patients with chronic kidney disease (CKD). We aimed to investigate whether NLR was an independent predictor of cardiovascular or all-cause mortality in CKD patients with or without hemodialysis by performing a meta-analysis.

Methods

Pubmed, Embase, and Cochrane Library databases are systematically searched for relevant literature that investigated NLR and subsequent cardiovascular or all-cause mortality risk in CKD with or without dialysis. Pooled hazard risk (HR) with 95% confidence interval (CI) was calculated for the high vs. low NLR category.

Results

A total of thirteen studies enrolling 116,709 patients were identified and analyzed. In summary, high NLR was associated with an increased risk of all-cause mortality (HR 1.93, 95% CI 1.87–2.00; P < 0.00001) and cardiovascular mortality (HR 1.45, 95% CI 1.18–1.79, P < 0.001). Subgroup analysis indicated that high NLR are independently associated with all-cause mortality risk in dialysis patients (HR 1.94, 95% CI 1.87–2.01; P < 0.00001).

Conclusions

This meta-analysis indicates a high NLR is related to all-cause mortality and cardiovascular mortality in patients with chronic kidney disease. Dialysis patients with high NLR are candidates at high risk of mortality to allow for earlier interventions. Further large scale and more rigorously designed studies are warranted to confirm the prognostic value of NLR in the different stages of CKD.

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Author notes

  1. Guangyu Ao, Yushu Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Nephrology, Chengdu First People’s Hospital, No.18 North Wanxiang Road, High-tech District, Chengdu, 610016, Sichuan, China

    Guangyu Ao & Huitao Wen

  2. Department of Cardiology, Chengdu First People’s Hospital, Chengdu, Sichuan, China

    Yushu Wang

  3. Department of Neurology, Chengdu Third People’s Hospital, Chengdu, Sichuan, China

    Xin Qi

  4. Department of Nephrology, Chengdu Second People’s Hospital, Chengdu, Sichuan, China

    Fengping Wang

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  1. Guangyu Ao
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Correspondence to Huitao Wen.

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All procedures performed in this study were in accordance with the ethical standards of the institutional and international research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Ao, G., Wang, Y., Qi, X. et al. Association of neutrophil-to-lymphocyte ratio and risk of cardiovascular or all-cause mortality in chronic kidney disease: a meta-analysis. Clin Exp Nephrol 25, 157–165 (2021). https://doi.org/10.1007/s10157-020-01975-9

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  • DOI: https://doi.org/10.1007/s10157-020-01975-9

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