High neutrophil/lymphocyte ratio is associated with poor renal outcomes in Japanese patients with chronic kidney disease

Figures & data

Table 1. Baseline clinical characteristics of total patients and patients stratified by values below and above the median NLR.

Variables	Total (n = 350)	Low NLR (n = 175)	High NLR (n = 175)	p
NLR	1.87 (1.44–2.47)	0.51–1.86	1.87–5.92
Age (years)	68 (55–77)	67 (53–75)	70 (60–78)	.02
Male (%)	239 (68)	110 (63)	129 (74)	.03
Smoking (%)	177 (51)	78 (45)	99 (57)	.02
Diabetes mellitus (%)	128 (37)	56 (32)	72 (41)	.08
Dyslipidemia (%)	246 (70)	119 (68)	127 (73)	.35
Systolic blood pressure (mmHg)	130 (118–141)	127 (117–138)	134 (120–145)	.03
Body mass index (kg/m^2)	22.6 (20.5–25.4)	22.7 (20.4–25.7)	22.3 (20.6–24.9)	.72
Daily proteinuria (g/day)	0.8 (0.2–2.1)	0.6 (0.2–1.8)	1.0 (0.3–2.2)	.49
Hemoglobin (g/dL)	11.6 (10.0–13.0)	11.9 (10.4–13.3)	11.0 (9.5–12.7)	<.01
CRP (mg/dL)	0.09 (0.05–0.17)	0.07 (0.05–0.15)	0.10 (0.05–0.19)	.02
eGFR (mL/min/1.73 m^2)	33.6 (22.6–56.8)	36.8 (26.6–70.3)	30.7 (20.9–43.4)	<.01
Neutrophils (/μL)	3094 (2449–3975)	2704 (2151–3212)	3643 (2909–4430)	<.01
Lymphocytes (/μL)	1703 (1279–2048)	1940 (1598–2347)	1499 (1111–1805)	<.01
Serum albumin (g/dL)	3.5 (3.2–3.8)	3.6 (3.2–3.9)	3.5 (3.2–3.8)	.31
Serum phosphorus (mg/dL)	3.5 (3.2–3.9)	3.5 (3.2–4.0)	3.5 (3.1–3.9)	.62
History of IHD (%)	57 (16)	21 (12)	36 (21)	.03

Values are expressed as the number (percent), or median (interquartile range).

NLR: neutrophil/lymphocyte ratio; CRP: C-reactive protein; eGFR: estimated glomerular filtration rate; IHD: ischemic heart disease.

Table 2. Relationships between NLR and clinical parameters.

	Univariable		Multivariable
Variables	β	p	β	p
Age (years)	0.14	.01	−0.12	.12
Male	0.13	.01	0.09	.18
Diabetes mellitus	0.05	.31	−0.04	.55
Systolic blood pressure (mmHg)	0.10	.07	0.07	.25
Smoking	0.08	.14	0.00	.99
Dyslipidemia	0.03	.58	−0.01	.85
Ischemic heart disease	0.18	<.01	0.13	.02
Body mass index (kg/m^2)	−0.01	.85	0.02	.77
Daily proteinuria (g/day)	0.02	.72	−0.11	.22
Hemoglobin (g/dL)	−0.17	<.01	−0.08	.31
eGFR (mL/min/1.73 m^2)	−0.26	<.01	−0.23	<.01
Serum phosphorus (mg/dL)	0.00	.93	−0.01	.83
Serum albumin (g/dL)	−0.06	.30	−0.08	.35
CRP (mg/dL)	0.15	<.01	0.11	.048

NLR: neutrophil/lymphocyte ratio; eGFR: estimated glomerular filtration rate; CRP: C-reactive protein.

Figure 1. Kaplan–Meier curves with log-rank tests of freedom from composite outcomes. Data were stratified according to the values below and above the median NLR. Solid line showed low NLR group’s Kaplan–Meier curve and dashed line showed high NLR group’s one.

Table 3. Hazard ratios for renal outcomes of high neutrophil count, low lymphocyte count, and high NLR groups by the Cox proportional hazard model.

	Incidence rate (100 person/year)	Model 1			Model 2			Model 3
		HR	95% CI	p	HR	95% CI	p	HR	95% CI	p
Low neutrophil group	6.63	(reference)			(reference)			(reference)
High neutrophil group	9.14	1.51	0.98–2.35	.06	1.29	0.83–2.01	.27	1.13	0.71–1.81	.60
High lymphocyte group	5.73	(reference)			(reference)			(reference)
Low lymphocyte group	9.81	1.51	0.96–2.40	.07	1.65	1.06–2.61	.03	1.14	0.68–1.93	.61
Low NLR group	4.96	(reference)			(reference)			(reference)
High NLR group	11.10	2.22	1.42–3.54	<.01	2.06	1.31–3.30	<.01	1.67	1.02–2.77	.04

Model 1: adjusted for age and sex.

Model 2: model 1 plus adjusted for smoking, diabetes mellitus, systolic blood pressure, and dyslipidemia.

Model 3: model 2 plus adjusted for use of immunosuppressants and/or renin–angiotensin–aldosterone system inhibitors at discharge, body mass index, daily proteinuria, hemoglobin, C-reactive protein, estimated glomerular filtration rate, serum albumin, serum phosphorus, and ischemic heart disease.

NLR: neutrophil/lymphocyte ratio; HR: hazard ratio; CI: confidence interval.