Association of neutrophil-to-lymphocyte ratio with early renal dysfunction and albuminuria among diabetic patients
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Neutrophil-to-lymphocyte ratio (NLR) was widely studied as a prognostic marker in various medical and surgical specialties, but its significance in diabetic kidney disease is not yet established.
The subjects comprised 199 men aged 73 ± 11 (mean ± standard deviation) years and 187 women aged 77 ± 10 years from a rural hospital. We examined the relationship between NLR calculated by analyzing differential leukocyte count in complete blood picture and renal function evaluated by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease Study Group equation and urinary albumin excretion (UAE).
NLR was negatively related to eGFR and positively related to UAE. Multiple linear regression analysis using eGFR and UAE as an objective variables, adjusted for confounding factors as explanatory variables showed that NLR (β = − 0.101, p = 0.009) as well as age, body mass index, serum uric acid, and presence of uric acid lowing medication were significantly and independently associated with eGFR, and NLR (β = 0.113, p = 0.031) as well as prevalence of cardiovascular disease, systolic blood pressure, presence of antihypertensive medication, presence of antilipidemic medication, and eGFR were significantly and independently associated with UAE. The multivariate-adjusted odds ratios (95% confidence interval) of NLR for stage 3a (eGFR < 60 mL/min/1.73 m2), stage 3b (eGFR < 45 mL/min/1.73 m2), and microalbuminuria (UAE ≥ 30 mg/g Cr) were 1.90 (1.02–3.56) and 2.99 (1.28–6.98), and 1.77 (1.04–3.01), respectively. Next, to examine the consistency of the observed association between NLR and eGFR, we performed subgroup analyses. There was a significant interaction (p = 0.006) only between the two groups regarding antihypertensive medication (absence: β = − 0.272, p < 0.001 and presence: β = − 0.029, p = 0.564).
Our data suggested that NLR might be important as a potential factor for evaluating patients with a higher degree of albuminuria among diabetic outpatients.
KeywordsNeutrophil-to-lymphocyte ratio Estimated glomerular filtration rate Albuminuria Renal dysfunction
This work was supported in part by a grant-in-aid from the Foundation for Development of Community (2017).
RK participated in the design of the study, performed the statistical analysis and drafted the manuscript. RK DN, AK, TA, YK, ToK, NO, and TeK contributed to the acquisition and interpretation of data. RK, DN, and TeK contributed to the conception and design of the statistical analysis. All authors read and approved the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee at which the studies conducted.
We obtained consent through opt-out procedure from all individual participants included in the study.
- 1.Ghaderian SB, Hayati F, Shayanpour S, Beladi SS, Mousavi (2015) Diabetes and end-stage renal disease; a review article on new concepts. J Renal Inj Prev 4:28–33Google Scholar
- 3.Gheith O, Farouk N, Nampoory N, Halim MA, Al-Otaibi T (2016) Diabetic kidney disease: world wide difference of prevalence and risk factors. J Nephropharmacol 5:49–56Google Scholar
- 7.Sen N, Afsar B, Ozcan F, Buyukkaya E, Isleyen A, Akcay AB, Yuzgecer H, Kurt M, Karakas MF, Basar N, Hajro E, Kanbay M (2013) The neutrophil to lymphocyte ratio was associated with impaired myocardial perfusion and long term adverse outcome in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. Atherosclerosis 228:203–210CrossRefGoogle Scholar
- 15.Azab B, Daoud J, Naeem FB, Nasr R, Ross J, Ghimire P, Siddiqui A, Azzi N, Rihana N, Abdallah M, Azzi N, Patel P, Kleiner M, El-Sayegh S (2012) Neutrophil-to-lymphocyte ratio as a predictor of worsening renal function in diabetic patients (3-year follow-up study). Ren Fail 34:571–576CrossRefGoogle Scholar
- 17.Akbas EM, Demirtas L, Ozcicek A, Timuroglu A, Bakirci EM, Hamur H, Ozcicek F, Turkmen K (2014) Association of epicardial adipose tissue, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with diabetic nephropathy. Int J Clin Exp Med 7:1794–1801Google Scholar
- 19.Youssef Moursy E (2015) Relationship between neutrophil-lymphocyte ratio and microvascular complications in Egyptian patients with type 2 diabetes. Am J Intern Med 3:250–255Google Scholar