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Abstract: SA-PO843

Monocyte/Lymphocyte Ratio Is a Better Predictor Than Neutrophil/Lymphocyte Ratio for Cardiovascular Events in Incident Dialysis Patients

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular


  • Kato, Sawako, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
  • Lindholm, Bengt, Baxter Novum & Renal Medicine Karolinska Institute, Stockholm, Sweden
  • Yuzawa, Yukio, Fujita Health University School of Medicine , Toyoake, AICHI-KEN, Japan
  • Tsuruta, Yoshinari, Meiyo Clinic, Toyohashi, Japan
  • Maruyama, Shoichi, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan

A higher neutrophil/ lymphocyte ratio (NLR) may indicate increased risk of cardiovascular disease (CVD) in incident dialysis patients (pts). However, recent studies suggest that monocyte/lymphocyte ratio (MLR) might a more sensitive predictor of CVD events than NLR, because the monocyte, a multifunctional immune professional cell and an ancestor of lipid-laden macrophages, may directly contribute to the progression of atherosclerosis. Here we explored the mortality predictive capacity of MLR among incident dialysis pts.


In an ongoing prospective cohort study, 132 incident Japanese dialysis pts (91 males, age 59 ±12 years) were enrolled and followed for a median of 48.7 months (range 1-113 months). Laboratory biomarkers including white blood cell count (WBC) - and its differential count - were determined at baseline.


Median MLR was 0.35 (range 0.46-0.27). The duration from start of dialysis therapy to the first CVD event was shorter in pts with higher MLR (Log rank 5.60, P=0.018). The number of CVD events per year was higher in pts with high MLR (18.6 events per 100 person-years) than in pts with low MLR (11.1 events per 100 person-years). In Cox hazard model, after adjustments for age, gender, smoking habits, and presence of diabetes, the pts with high MLR and high monocyte count – treated as continuous variables - had a significantly increased relative risk of CVD (5.64, 95% CI; 1.1-24.8, P = 0.028; and 7.17, 95% CI; 1.1-43.5, P = 0.037, respectively). However, the relations of CVD events to NLR or to neutrophil and lymphocyte counts were not significant.


In Japanese incident dialysis pts, a higher MLR and higher monocyte count associated with increased long-term risk of CVD events. These results may suggest that an increased circulating number of monocytes might play a role in the development of atherosclerosis in chronic kidney disease pts, possibly through differentiation of monocytes into macrophages in plaques, or by other mechanisms.


  • Government Support - Non-U.S.