Hematological-based immuno-inflammatory indices in dialysis-dependent chronic kidney disease patients: a single-center study

Background
Malnutrition, inflammation, and atherosclerosis interact in further kidney disease progression. Despite continuous improvement in renal clearance techniques, indicators of morbidity and mortality are still high for people with end-stage renal disease. The current work aims to study the role of hematological parameters as markers of inflammation and malnutrition in dialysis-dependent chronic kidney disease patients.


Patients and method
The study included 51 patients on chronic hemodialysis and 10 healthy controls. Malnutrition-Inflammation Score (MIS), prognostic nutritional index (PNI), neutrophil/lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and platelet/lymphocyte ratio (PLR) were calculated.


Results
There was a statistically significant difference between the studied groups regarding PNI and MIS scores (P=0.016 for each) and PLR and regarding SII (P<0.001, for each). There was a statistically highly significant difference between SII and each of NLR, PLR, neutrophils, hemoglobin, and platelets (P<0.001, for each). Also, there was a statistically significant difference between SII and each of the total white blood cells (WBCs) and HbA1c (P=0.028 and 0.001, respectively). There was a statistically significant difference between PNI and each of total WBCs, platelets, albumin, and erythrocyte sedimentation rate (P=0.003, 0.008, 0.001, 0.021, respectively). Also, there was a statistically highly significant difference between PNI and lymphocytes (P<0.001). There was a statistically highly significant difference between NLR and each of SII and neutrophils (P<0.001, for each). Also, there was a statistically significant difference between NLR and each of the total WBCs, PLR, and erythrocyte sedimentation rate (P=0.001, 0.04, 0.001, respectively).


Conclusion
Disturbances in hematological-based indices such as NLR, PLR, MIS, and SII in end-stage renal disease patients can affect the outcome of chronic hemodialysis patients.