Relationship between late arteriovenous fistula (AVF) stenosis and neutrophil–lymphocyte ratio (NLR) in chronic hemodialysis patients

Figures & data

Table 1. Baseline characteristics and laboratory parameters of study population.

Parameters	AVF stenosis	AVF without stenosis	p Value
Patient numbers	64	44
Age, years	55.2 ± 18.8	54.5 ± 11.9	0.932
Sex, male/female	33/31	23/21	0.881
BMI	28.47 ± 6.17	28.29 ± 4.76	0.904
SBP, mmHg	144.25 ± 14.28	145.93 ± 13.85	0.641
DBP, mmHg	94.38 ± 10.75	95.19 ± 11.72	0.332
Smoking, n (%)	19 (29.6)	12 (27.3)	0.726
History of CVD, n (%)	21 (32.8)	14 (31.8)	0.623
HD duration, months	33.5 ± 12.8	32.7 ± 11.9	0.765
Albumin, g/dL	3.76 ± 0.68	3.73 ± 0.56	0.005
Ca (corrected), mg/dL	8.02 ± 0.64	8.10 ± 0.55	0.422
P, mg/dL	6.29 ± 1.51	6.13 ± 1.49	0.375
Ca × P product mg^2/dL^2	48.29 (16.22)	48.92 (15.61)	0.795
iPTH, pg/mL	371.70 ± 301.04	361.57 ± 327.48	0.815
HDL-C, mg/dL	31.8 ± 12.6	51.5 ± 11.9	< 0.001
Triglycerides, mg/dL	195.58 ± 89.41	198.78 ± 96.436	0.865
LDL-C, mg/dL	102.69 ± 36.13	99.86 ± 39.49	0.378
Hb, g/dL	10.83 ± 1.97	10.75 ± 1.82	0.848
TSAT, %	28.99 (9.77)	27.82 (11.43)	0.382
Ferritin, ng/mL	542.43 ± 230.45	539.15 ± 286.37	0.657
CRP, mg/L	9.75 ± 11.97	8.94 ± 12.3	0.502
Uric acid, mg/dL	7.29 ± 1.28	7.38 ± 1.53	0.589
WBC	7650 ± 2100	7820 ± 2215	0.713
NLR	3.47 ± 0.46	2.27 ± 0.22	< 0.001
Weekly Epo dose, IU	8468.8 ± 5234.9	8470.6 ± 5360.5	0.999
ACE or ARB, n (%)	40 (62.5)	28 (63.6)	0.897
ß-Blockers, n (%)	19 (29.6)	14 (31.8)	0.578
CCB, n (%)	22 (33.4)	15 (34.1)	0.659
Alpha-blockers, n (%)	7 (10.6)	5 (11.4)	0.731

Note: ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; AVF, arteriovenous fistula; BMI, body mass index; Ca, calcium; CCB, calcium channel blockers; CRP, C-reactive protein; DBP, diastolic blood pressure; Epo, erythropoietin; Hb, hemoglobin; HDL-C, high-density lipoprotein cholesterol; iPTH, intact parathyroid hormone; LDL-C, low-density lipoprotein cholesterol; NLR, neutrophil–lymphocyte ratio' P, phosphate, SBP, systolic blood pressure; SD, standard deviation; TSAT, transferrin saturation; and WBC, white blood cell.

Table 2. CDUS and fistulographic findings of AVF stenosis.

	Category	n (%)
Color Doppler ultrasonography  (n = 104)
Luminal diameter reduction  (n = 104)	≥50 %	67 (62)
	<50%	41 (38)
A peak systolic velocity ratio  (n = 104)	≥2:1	68 (62.9)
	<2:1	40 (37.1)
Peak systolic flow velocity  (n = 104)	>400 cm/s	65 (60.1)
	<400 cm/s	43 (69.9)
Fistulography with DSA  (n = 64)
Degree of stenosis (n = 64)
Total occlusion	100%	4 (6.25)
Stenosis	90–99%	14 (21.9)
	75–89%	25 (39)
	50–74%	21 (32.85)
Number of lesions (n = 64)	One site	59 (92.2)
	Two sites	4 (6.25)
	≥3 sites	1 (1.55)
Location of lesions  (total lesions = 70)	Native artery	3 (4.2)
	Arteriovenous anastomosis	19 (27.1)
	Juxtaanastomotic vein	33 (47.1)
	Venous outflow	10 ( 14.3)
	Distal outflow	5 (7.2)
	Central venous system	0

Figure 1. NLR is associated with degree of AVF stenosis.

Table 3. Significant predictors of late AVF stenosis in univariable and multivariable logistic regression analyses.

	Univariate OR (95% CI)	p Value	Multivariate OR (95% CI)	p Value
Age, year	0.965 (0.945–1.023)	0.846
BMI, kg/m^2	0.832 (0.761–1.109)	0.741
Smoker	0.997 (0.965–1.056)	0.875
HD duration (months)	2.045 (1.456–2.698)	0.038	1.345 (0.978–2.145)	0.276
Ca × P product (mg^2/dL^2)	0.940 (0.894–0.997)	0.918
Albumin (g/dL)	0.988 (0.968–1.035)	0.906
HDL <30 (mg/L)	3.789 (2.078–4.135)	< 0.001	2.976 (1.654–4.125)	0.034
LDL (mg/L)	1.116 (0.956–1.245)	0.753
WBC (/µL)	1.294 (1.023–1.397)	0.795
Hb (g/dL)	0.915 (0.903–0.975)	0.539
CRP (mg/L)	1.296 (1.190–1.305)	0.646
iPTH, pg/mL	1.170 (1.056–1.234)	0.416
TSAT (%)	1.072 (1.008–1.121)	0.357
NLR	6.611 (3.567–8.912)	< 0.001	4.734 (2.987–7.321)	0.001

Figure 2. ROC analysis showed that best cut-off of NLR is 2.70 for prediction of late AVF stenosis.