Association of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio with Diabetic Kidney Disease in Chinese Patients with Type 2 Diabetes: A Cross-Sectional Study

Figures & data

Table 1 Characteristics of Subjects Categorized by the UACR

Variable	Normoalbuminuria (N = 290)	Microalbuminuria (N = 190)	Macroalbuminuria (N = 175)	P-value
Male/Female (N)	154/136	103/87	94/81	0.971
Age (year)	59.04±10.63	60.23±11.39	61.13±9.66	0.111
Duration of diabetes (month)	91.46±82.16	115.81±88.60	138.33±90.09	<0.001
Body mass index (kg/m^2)	24.91±3.29	25.09±3.57	25.25±3.05	0.560
Systolic blood pressure (mmHg)	126.89±13.45	128.03±10.65	128.97±10.50	0.181
Diastolic blood pressure (mmHg)	79.36±10.27	80.19±10.33	80.81±7.08	0.269
WBC (×10^9/L)	6.26±1.25	6.80±1.57	6.97±1.59	<0.001
Neutrophil count (×10^9/L)	3.82±0.95	4.56±1.34	4.86±1.33	<0.001
Lymphocyte count (×10^9/L)	1.97±0.51	1.76±0.52	1.60±0.48	<0.001
Platelet count (×10^9/L)	202.87±44.67	204.62±46.18	206.37±40.85	0.704
NLR	2.21±0.72	3.00±1.12	3.61±1.05	<0.001
PLR	108.78±36.58	122.52±35.37	135.48±41.40	<0.001
Serum creatinine (μmol/L)	62.12±13.07	74.94±13.30	89.34±16.38	<0.001
Blood urea nitrogen (mmol/L)	6.05±1.18	6.31±1.57	6.57±1.22	<0.001
Serum uric acid (μmol/L)	305.35±60.99	308.09±60.24	312.75±72.41	0.483
eGFR (mL/min/1.73m^2)	102.26±12.40	96.75±8.84	76.65±6.68	<0.001
Total cholesterol (mmol/L)	4.40±1.14	4.50±1.39	4.60±0.89	0.191
Triglyceride (mmol/L)	1.89±1.04	2.05±1.21	2.39±0.96	<0.001
HDL cholesterol (mmol/L)	1.10±0.33	1.09±0.36	1.06±0.37	0.463
LDL cholesterol (mmol/L)	2.68±0.93	2.88±0.82	2.98±0.71	<0.001
Fasting plasma glucose (mmol/L)	8.54±2.32	8.76±2.06	9.12±2.04	0.020
Hemoglobin A1c (%)	8.61±1.88	8.88±2.11	9.10±1.88	0.030
Metformin (%)	61.0	61.6	57.7	0.710
SGLT-2 inhibitors (%)	22.1	26.8	29.7	0.164
GLP-1 receptor agonists (%)	5.9	7.9	8.6	0.494
DPP-4 inhibitors (%)	8.6	12.6	14.9	0.103
Statins (%)	28.3	30.5	25.1	0.518
ACE inhibitors (%)	11.4	21.1	28.6	<0.001
ARBs (%)	7.9	29.5	37.1	<0.001

Notes: P-value: ANOVA for continuous variables or the χ² test for categorical variables. The numbers in bold indicate significance.

Abbreviations: WBC white blood cell, NLR neutrophil-to-lymphocyte ratio, PLR platelet-to-lymphocyte ratio, HDL high-density lipoprotein, LDL low-density lipoprotein, eGFR estimated glomerular filtration rate, SGLT-2 sodium-glucose cotransporter 2, GLP-1 glucagon-like peptide 1, DPP-4 dipeptidyl peptidase-4, ACE angiotensin-converting-enzyme; ARBs angiotensin-receptor blockers.

Figure 1 The distributions of the NLR and PLR among the three groups. (A) The distributions of the NLR among the three groups. (B) The distributions of the PLR among the three groups. NLR and PLR increased with increasing albuminuria (all p<0.001).

Table 2 Pearson’s Correlation Analysis Between NLR, PLR and Renal Function Indexes

Variable	NLR		PLR
	r	P-value	r	P-value
eGFR	−0.386	<0.001	−0.166	<0.001
UACR	0.508	<0.001	0.287	<0.001

Abbreviations: NLR neutrophil-to-lymphocyte ratio, PLR platelet-to-lymphocyte ratio, eGFR estimated glomerular filtration rate, UACR urinary albumin-to-creatinine ratio.

Figure 2 Relationship between NLR, PLR and renal function indexes. Relationship between NLR and UACR (A), between NLR and eGFR (B), between PLR and UACR (C), between PLR and eGFR (D).

Table 3 Risk Factors for DKD in Patients with Type 2 Diabetes

Variable	P-value	OR	95% CI
Duration of diabetes	0.039	1.003	1.000–1.005
NLR	<0.001	3.137	1.955–5.033
PLR	0.038	1.008	1.000–1.015
Serum creatinine	<0.001	1.092	1.072–1.112
LDL cholesterol	0.011	1.414	1.084–1.844
Hemoglobin A1c	0.016	1.103	1.018–1.195

Notes: OR odds ratio, 95% CI 95% confidence interval.

Abbreviations: NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; LDL, low-density lipoprotein.

Figure 3 Receiver operating characteristic (ROC) curve analysis of NLR and PLR for DKD prediction.