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Kidney Week

Abstract: TH-PO489

The Association between Neutrophil to Lymphocyte Ratio and Severity of Coronary Artery Disease in Patients with CKD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Kim, Il Young, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
  • Park, In seong, Pusan National University Hospital, Busan, Busan, Korea (the Republic of)
  • Kim, Min Jeong, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
  • Han, Miyeun, Pusan National University Hospital, Busan, Busan, Korea (the Republic of)
  • Rhee, Harin, Pusan National University Hospital, Busan, Busan, Korea (the Republic of)
  • Song, Sang Heon, Pusan National University Hospital, Busan, Busan, Korea (the Republic of)
  • Seong, Eun Young, Pusan National University Hospital, Busan, Busan, Korea (the Republic of)
  • Lee, Dong Won, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
  • Lee, Soo Bong, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
  • Kwak, Ihm Soo, Pusan National University Hospital, Busan, Busan, Korea (the Republic of)
Background

Chronic inflammation is associated with increased cardiovascular mortality in patients with chronic kidney disease (CKD). Neutrophil to lymphocyte ratio (NLR) was introduced as a potential marker of inflammation in cardiac disorder. Emerging evidence have suggested that NLR might be a useful marker of cardiovascular disease. This study aimed to investigate the association between NLR and severity of coronary artery disease (CAD) in patients with CKD.

Methods

A total of 952 pre-dialysis CKD patients [estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2] who underwent elective coronary angiography (CAG) were studied. Depending on eGFR, study subjects were categorized into 3 groups (stage 3: n = 617, stage 4: n = 240, stage 5: n = 95). NLR values were calculated from complete blood count before CAG. The severity of CAD was evaluated by Gensini score according to the degree of luminal narrowing and location(s) of obstruction in the involved main coronary artery. A significant CAD was defined as lumen narrowing of one or more main coronary artery ≥ 50%.

Results

In univariate analysis, Gensini score correlated with NLR (r = 0.542, P < 0.001), age (r = 0.123, P < 0.001), diabetes mellitus (DM) (r = 0.124, P < 0.001), hypertension (r = 0.133, P < 0.001), smoking (r = 0.088, P = 0.007), eGFR (r = -0.343, P < 0.001), uric acid (r = 0.390, P = 0.001), calcium (r = -0.097, P = 0.003), phosphate (r = 0.107, P = 0.001), total cholesterol (r = 0.115, P < 0.001), CRP (r = 0.292, P < 0.001), and hemoglobin (r = -0.225, P < 0.001). In multiple regression analysis, NLR (β = 0.468, P < 0.001), age (β = 0.064, P = 0.013), DM (β = 0.07, P = 0.007), hypertension (β = 0.068, P = 0.009), eGFR (β = -0.227, P < 0.001), total cholesterol (β = 0.063, P = 0.015), and CRP (β = 0.095, P = 0.001) were independent predictors of Gensini score. In ROC analysis (AUC: 0.741, 95% CI: 0.710-0.772), the best cut-off value of NLR for identifying the significant CAD was 2.26 with associated sensitivity of 70.2% and specificity of 67.2%.

Conclusion

A higher NLR was an independent predictor of the severity of CAD in CKD patients. NLR could be a valuable measure for CAD risk stratification in CKD patients.