Neutrophil-Lymphocyte Ratio as Predictor of Mortality in Regular Hemodialysis Patients at Tabanan General Hospital

Abstract

The risk of mortality in chronic kidney disease (CKD) patients is higher than in normal population. Inflammation has an important role in the high mortality in CKD patients undergoing hemodialysis (HD). The neutrophil lymphocyte ratio (NLR) is a simple parameter and has been widely associated with poor outcomes in HD patients but has not been widely implemented in Indonesia, especially in Bali. This research prospectively analyzed survival of 186 patients aged 18-90 years undergoing regular HD 2x/week for at least 3 months. NLR was calculated by dividing the absolute number of neutrophils and lymphocytes. The Survival test was performed by the Kaplan-Meier method and compared with the log-rank test. Univariate and multivariate tests were performed to assess the prognostic impact of NLR and other clinical factors on all-cause mortality in HD patients. Mortality was found higher in the group with high NLR values (p-value 0.003). High NLR was significantly associatedwith all-causemortality (HR 3.206; 95% CI 1.467 – 7.004; p value 0.003) and remained an independent factor on mortality in routine HD patients after adjustment toothervariables(aHR 2.696, 95% CI 1.176 –6.182, p-value: 0.019). Inconclusion, HighNLR is independently associated with all-cause mortality in CKD patients undergoing regular HD. NLR can be used as an inflammation marker that is considered easy and affordable and can be used to help determine populations that require special attention in order to reduce the mortality of patients with HD.