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Clinical and Experimental Nephrology

, Volume 17, Issue 4, pp 532–540 | Cite as

Neutrophil to lymphocyte ratio independently predicts cardiovascular events in patients with chronic kidney disease

  • Yalcin Solak
  • Mahmut Ilker Yilmaz
  • Alper Sonmez
  • Mutlu Saglam
  • Erdinc Cakir
  • Hilmi Umut Unal
  • Mahmut Gok
  • Kayser Caglar
  • Yusuf Oguz
  • Mujdat Yenicesu
  • Murat Karaman
  • Seyit Ahmet Ay
  • Abduzhappar Gaipov
  • Suleyman Turk
  • Abdulgaffar Vural
  • Juan J. Carrero
Original Article

Abstract

Background

Increased inflammation is common in patients with chronic kidney disease (CKD) and is associated with increased adverse cardiovascular events (CVE). Neutrophil-to-lymphocyte ratio (NLR) was used to predict survival in patients with acute coronary syndrome. We aimed to evaluate predictive ability of NLR in CKD patients.

Methods

225 subjects with stage 3–5 CKD were followed for a mean of 39 months. Fatal and nonfatal CVE were recorded during this period. NLR at baseline was determined from complete blood count differential. Endothelial dysfunction (flow-mediated dilation, FMD), hsCRP and insulin resistance were determined. We investigated if NLR could predict development of fatal and nonfatal CVE. We also looked at how NLR and its individual components change across CKD stages and whether NLR is related to CRP, insulin resistance and endothelial dysfunction.

Results

There were 70, 74 and 81 patients in groups of CKD stage-3, stage-4 and stage-5, respectively. Median NLR was 2.81. NLR showed a significant increase from stage 3 to stage 5. NLR was inversely associated with FMD independent of hsCRP. 14 fatal and 52 nonfatal CVE occurred during follow-up period. NLR could predict composite CVE independent of insulin resistance and hsCRP. Increased NLR over 2.81 was related to a significantly decreased survival time (log-rank Chi-square = 14.833, P < 0.0001). A cutoff value for NLR ≥3.76 could predict development of composite CVE with 80.3 % sensitivity and 91.8 % specificity.

Conclusions

NLR is independently related to endothelial dysfunction and could predict composite cardiovascular endpoints independent of traditional confounding factors in patients with moderate to severe CKD.

Keywords

Cardiovascular events Chronic kidney disease Endothelial dysfunction Neutrophil to lymphocyte ratio 

Notes

Acknowledgments

Dr. Juan J. Carrero acknowledges grant support from the Swedish Research Council. Dr. A. Gaipov received grant support from the ERA-EDTA fellowship program. No sources of funding were used to conduct this study or prepare this manuscript.

Conflict of interest

All the authors declared no competing interests and all authors had access to the data and played a role in writing this manuscript.

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Copyright information

© Japanese Society of Nephrology 2012

Authors and Affiliations

  • Yalcin Solak
    • 1
  • Mahmut Ilker Yilmaz
    • 2
  • Alper Sonmez
    • 3
  • Mutlu Saglam
    • 4
  • Erdinc Cakir
    • 5
  • Hilmi Umut Unal
    • 2
  • Mahmut Gok
    • 2
  • Kayser Caglar
    • 2
  • Yusuf Oguz
    • 2
  • Mujdat Yenicesu
    • 2
  • Murat Karaman
    • 6
  • Seyit Ahmet Ay
    • 6
  • Abduzhappar Gaipov
    • 1
  • Suleyman Turk
    • 1
  • Abdulgaffar Vural
    • 2
  • Juan J. Carrero
    • 7
  1. 1.Department of Nephrology, Meram Tip Fakultesi, Hemodiyaliz SekreterliğiSelcuk University, Meram School of MedicineMeramTurkey
  2. 2.Department of NephrologyGülhane School of MedicineAnkaraTurkey
  3. 3.Department of EndocrinologyGülhane School of MedicineAnkaraTurkey
  4. 4.Department of RadiologyGülhane School of MedicineAnkaraTurkey
  5. 5.Department of BiochemistryGülhane School of MedicineAnkaraTurkey
  6. 6.Department of Internal MedicineGülhane School of MedicineAnkaraTurkey
  7. 7.Division of Renal MedicineKarolinska University Hospital at HuddingeStockholmSweden

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