Kidney Week

Abstract: FR-PO744

The Role of Neutrophil/Lymphocyte Ratio as a New Paradigm to Determine Hemodialysis Initiation

Session Information

• Dialysis: Inflammation and Infection
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Lee, Tae won, Gyeongsang National University Changwon Hospital, Changwon-si, Gyeongsangnam-do, Korea (the Republic of)

Tae won Lee,

• Jang, Ha nee, Gyeongsang National University Hospital, Jinju-si, Gyeongsangnam-do, Korea (the Republic of)

Ha nee Jang,

• Kwak, Ji-Hye, Gyeongsang National University Hospital, Jinju-si, Gyeongsangnam-do, Korea (the Republic of)

Ji-Hye Kwak,

• Bae, Eunjin, Gyeongsang National University Changwon Hospital, Changwon-si, Gyeongsangnam-do, Korea (the Republic of)

Eunjin Bae,

• Cho, Hyun Seop, Gyeongsang National University Hospital, Jinju-si, Gyeongsangnam-do, Korea (the Republic of)

Hyun Seop Cho,

• Kim, Hyun-Jung, School of Medicine, Gyeongsang National University, Jinju, Korea (the Republic of)

Hyun-Jung Kim,

• Chang, Se-Ho, Gyeongsang National University Hospital, Jinju-si, Gyeongsangnam-do, Korea (the Republic of)

Se-Ho Chang,

• Park, Dong Jun, Gyeongsang National University Changwon Hospital, Changwon-si, Gyeongsangnam-do, Korea (the Republic of)

Dong Jun Park,

Background

There are still much controversies about the timing of initiation of the dialysis in patients with chronic kidney disease (CKD) although absolute and relative indications have been well established. This study underwent to evaluate whether neutrophil/lymphocyte ratio (NLR) could be used as an important index of dialysis initiation by comparing the other clinical presentations and biochemical findings.

Methods

We retrospectively evaluated the medical records of patients to start chronic maintenance hemodialysis from January 2011 to December 2016 in our institutions. We compared laboratory findings of the last 3 months with those of just before timing of dialysis initiation. Patients with acute infection, using steroid or immunosuppressive agent use, and undergoing acute hemodialysis for acute kidney injury were excluded.

Results

Total 300 patients were included. The mean age was 61 years old. The mean estimated glomerular filtration rate (eGFR) by MDRD was 5.93 ± 2.78 (ml/min/1.73m²) at the time of hemodialysis, whereas it was 7.86 ± 3.28 (ml/min/1.73m²) 3 months before hemodialysis (p<0.001). The mean NLR significantly increased from 2.50 ± 1.02 to 4.32 ± 2.08 (p<0.001) in this duration. We found significant correlations between NLR and hemoglobin (r=-0.523, p<0.001), serum albumin level (r=-0.685, p<0.001), serum phosphorus level (r=0.465, p<0.001), total CO₂ level (r=-0.361, p<0.012), and CRP level (r=0.458, p<0.001). In addition, patients undergoing planed dialysis through prepared arm vascular access showed significantly lower NLR than those of emergency dialysis requiring Perm-cath or temporary catheter (3.58 ± 1.55 vs.4.75 ± 2.23, p<0.001) although eGFR was not different between two groups. Lower hemoglobin, total CO₂, albumin, sodium and calcium level was shown in patients undergoing emergency dialysis, compared with patients using planned arm vascular access (p<0.001, p=0.002, p<0.001, p=0.006, and p=0.002, respectively).

Conclusion

In conjunction with many other components, NLR might be used valuable marker in CKD patients when clinician consider the initiation of renal replacement therapy or prepare vascular access.