Progress in the application of the neutrophil-to-lymphocyte ratio in dialysis-related complications

Figures & data

Figure 1. Diagram of potential clinical applications of the neutrophil-to-lymphocyte ratio in the diagnosis and prognosis of complications associated with hemodialysis and peritoneal dialysis. EPO, erythropoietin; NK cells, natural killer cells.

Table 1. Application of the neutrophil to lymphocyte ratio in hemodialysis-related complications.

Area	Related complications	Significance of NLR	Reference
Cardiovascular	Left ventricular hypertrophy	Increased NLR level predicted left ventricular hypertrophy. NLR ≥3.5 was strongly associated with an increased risk of all-cause death and cardiovascular death.	[17]
	Vascular calcification	High NLR indicated coronary artery calcification and thoracic aortic calcification.	[15]
	Cardiac valve calcification	Degree of heart valve calcification was positively correlated with the NLR.	[19]
	Arteriosclerosis	Low NLR was associated with higher low-density lipoprotein levels. NLR predicted arterial stiffness.	[23,29]
Infection	Catheter-related bloodstream infection	NLR had a certain value in the diagnosis of catheter-related bloodstream infection.	[33,34]
	Pulmonary infection	NLR was an independent risk factor of pulmonary infection. NLR was positively correlated with disease severity and mortality in patients with coronavirus disease 2019.	[36,38]
Other	Protein-energy malnutrition	NLR was negatively correlated with serum albumin levels. There was a significant direct correlation between baseline NLR and body mass index.	[44]
	Stenosis of internal arteriovenous fistula	NLR was an independent predictor of arteriovenous fistula stenosis. Elevated NLR may be a risk factor for early AVF restenosis after successful percutaneous transluminal angioplasty.	[45,46]
	Vitamin D deficiency	Significant negative correlation between NLR and serum vitamin D levels; an elevated NLR typically indicated vitamin D insufficiency.	[48]
	Anemia	High NLR predicted poor erythropoietin responsiveness.	[49]
	Frailty	NLR was independently associated with frailty and had a certain diagnostic value for frailty.	[51]

NLR, neutrophil-to-lymphocyte ratio.

Table 2. Application of the neutrophil to lymphocyte ratio in peritoneal dialysis-related complications.

Area	Related complications	Significance of NLR	Reference
Cardiovascular	Adverse cardiovascular events	Increased NLR was predictive of adverse cardiovascular events in patients <60 years. Compared with patients with a high NLR, those with a low NLR had a higher survival rate. High NLR was an independent prognostic indicator of all-cause mortality. Increased NLR was significantly associated with increased all-cause mortality.	[56–58]
	Left ventricular systolic dysfunction	NLR >3.6 was significantly associated with left ventricular systolic dysfunction.	[59]
	Arteriosclerosis	NLR was independently associated with brachial-ankle pulse wave velocity and was an independent risk factor for increased arterial stiffness.	[61]
	Stroke	High NLR was an independent risk factor for first stroke.	[65]
Infection	Peritoneal dialysis-associated peritonitis	A higher NLR at the onset of peritoneal dialysis-associated peritonitis was linearly associated with an increased risk of treatment failure.	[67]
	Pneumonia	Incidence of first pneumonia was greater in the high NLR group than that in the low NLR group; the risk of pneumonia in patients with a high NLR was significantly increased.	[71]
Other	Mortality	Elevated NLR was a significant risk factor for early death, NLR >3.71 indicated a lower survival rate.	[73]
	EPO-hyporesponsive anemia	High NLR was associated with a non-significantly increased erythropoietin resistance index, but no direct correlation was established.	[5]

NLR, neutrophil-to-lymphocyte ratio.

Li H, Lu X, Xiong R, et al. High neutrophil-to-lymphocyte ratio predicts cardiovascular mortality in chronic hemodialysis patients. Mediators Inflamm. 2017;2017:9327136–9327138. doi:10.1155/2017/9327136.

 PubMed Web of Science ®Google Scholar

Chandra A, Raj G, Awasthi NP, et al. Evaluation of the relationship between blood cell parameters and vascular calcification in dialysis-dependent end-stage renal disease patients. Saudi J Kidney Dis Transpl. 2020 Jan-Feb;31(1):136–143.

 PubMed Web of Science ®Google Scholar

Yun-Dan W, Jiang W. Correlation between hs-CRP, NLR, PLR and cardiac valve calcification in maintenance hemodialysis patients. J Clin Nephrol. 2020;20(2):109–113.

 Google Scholar

Zhang Y, Ruan Y, He Q, et al. Clinical significance of neutrophil to lymphocyte ratio in maintenance hemodialysis patients. Chin J Nephrol. 2016;32(9):659–664.

 Google Scholar

Yu XY, Li XS, Li Y, et al. Neutrophil-lymphocyte ratio is associated with arterial stiffness in postmenopausal women with osteoporosis. Arch Gerontol Geriatr. 2015 Jul-Aug;61(1):76–80. doi:10.1016/j.archger.2015.03.011.

 PubMed Web of Science ®Google Scholar

Laupland KB, Gregson DB, Zygun DA, et al. Severe bloodstream infections: a population-based assessment. Crit Care Med. 2004 Apr;32(4):992–997. doi:10.1097/01.ccm.0000119424.31648.1e.

 PubMed Web of Science ®Google Scholar

Yang J, Wang H, Hua Q, et al. Diagnostic value of systemic inflammatory response index for catheter-related bloodstream infection in patients undergoing haemodialysis. J Immunol Res. 2022;2022:7453354.

 PubMed Web of Science ®Google Scholar

Li LL, Yang YQ, Qiu M, et al. The clinical significance of neutrophil-lymphocyte ratio in patients treated with hemodialysis complicated with lung infection. Medicine (Baltimore). 2021 Jul;100(29):e26591. doi:10.1097/MD.0000000000026591.

 PubMed Web of Science ®Google Scholar

Simadibrata DM, Calvin J, Wijaya AD, et al. Neutrophil-to-lymphocyte ratio on admission to predict the severity and mortality of COVID-19 patients: a meta-analysis. Am J Emerg Med. 2021 Apr;42:60–69. doi:10.1016/j.ajem.2021.01.006.

 PubMed Web of Science ®Google Scholar

Diaz-Martinez J, Campa A, Delgado-Enciso I, et al. The relationship of blood neutrophil-to-lymphocyte ratio with nutrition markers and health outcomes in hemodialysis patients. Int Urol Nephrol. 2019 Jul;51(7):1239–1247. doi:10.1007/s11255-019-02166-6.

 PubMed Web of Science ®Google Scholar

Yilmaz H, Bozkurt A, Cakmak M, et al. Relationship between late arteriovenous fistula (AVF) stenosis and neutrophil-lymphocyte ratio (NLR) in chronic hemodialysis patients. Ren Fail. 2014 Oct;36(9):1390–1394. doi:10.3109/0886022X.2014.945183.

 PubMed Web of Science ®Google Scholar

Çildağ MB, Çildağ S, Köseoğlu ÖF. The relationship between neutrophil-lymphocyte ratio and primary patency of percutaneous transluminal angioplasty in hemodialysis arteriovenous fistula stenosis when using conventional and drug-eluting balloons. Cardiovasc Intervent Radiol. 2016 Dec;39(12):1702–1707. doi:10.1007/s00270-016-1442-y.

 PubMed Web of Science ®Google Scholar

Kara AV, Soylu YE. The relationship between vitamin D and inflammatory markers in maintenance hemodialysis patients. Int Urol Nephrol. 2019 Sep;51(9):1659–1665. doi:10.1007/s11255-019-02250-x.

 PubMed Web of Science ®Google Scholar

Zhang J, Lu X, Wang S, et al. Neutrophil-to-lymphocyte ratio and erythropoietin resistance among maintenance hemodialysis patients. Blood Purif. 2022;51(8):708–713. doi:10.1159/000519644.

 PubMed Web of Science ®Google Scholar

Wang J, Huang L, Xu M, et al. Study on the clinical implications of NLR and PLR for diagnosing frailty in maintenance hemodialysis patients and their correlations with patient prognosis. J Healthc Eng. 2022;2022:1267200. doi:10.1155/2022/1267200.

 PubMed Web of Science ®Google Scholar

Angkananard T, Janma J, Wannasiri T, et al. Associations of left ventricular systolic dysfunction with the factors among Thai patients on peritoneal dialysis: a cross-sectional study. BMC Nephrol. 2019 Jul;20(1):257. doi:10.1186/s12882-019-1418-7.

 PubMedGoogle Scholar

Cai K, Luo Q, Zhu B, et al. Neutrophil-lymphocyte ratio is associated with arterial stiffness in patients with peritoneal dialysis. BMC Nephrol. 2016 Nov;17(1):191. doi:10.1186/s12882-016-0394-4.

 PubMedGoogle Scholar

Guo G, Zeng Y, Chen Q, et al. High neutrophil/lymphocyte ratio as an independent risk factor for the first occurrence of stroke in peritoneal dialysis patients. Iran J Kidney Dis. 2020 Jul;14(4):282–289.

 PubMed Web of Science ®Google Scholar

He P, He LJ, Huang C, et al. Neutrophil-to-lymphocyte ratio and treatment failure in peritoneal dialysis-associated peritonitis. Front Med (Lausanne). 2021;8:699502. doi:10.3389/fmed.2021.699502.

 PubMed Web of Science ®Google Scholar

Zhang Y, Lai X, Chen Q, et al. The relationship between neutrophil-to-lymphocyte ratio and the first occurrence of pneumonia in peritoneal dialysis patients. Clin Exp Nephrol. 2020 Sep;24(9):770–778. doi:10.1007/s10157-020-01894-9.

 PubMed Web of Science ®Google Scholar

Liu X, Huang R, Wu H, et al. Patient characteristics and risk factors of early and late death in incident peritoneal dialysis patients. Sci Rep. 2016 Aug;6(1):32359. doi:10.1038/srep32359.

 PubMedGoogle Scholar

Pineault J, Lamarche C, Bell R, et al. Association of neutrophil-to-lymphocyte ratio with inflammation and erythropoietin resistance in chronic dialysis patients. Can J Kidney Health Dis. 2017;4:2054358117735563. doi:10.1177/2054358117735563.

 Google Scholar