Monocyte/lymphocyte Ratio Is Associated With Cardiovascular Events And Mortality In Peritoneal Dialysis Patients

ObjectivesSeveral studies have suggested peritoneal dialysis(PD)patients are at 5-to 10-fold higher risk for developing cardiovascular disease(CVD)than the general population.And CVD is the first etiology of mortality and morbidity among PD patients,accounting for nearly 40-50%of all deaths in the patients with PD.The causes of high CVD mortality related to CKD have been attributed to inflammation,which has been recognized as an important component of CKD,playing a unique role in the development of CVD.Elevated inflammatory markers may indicate an incresed risk of CVD.Therefore,the discovery of new inflammatory markers is very important to confirm inflammation and CVD risk in patients with PD.Previous studies in other populations have suggested that Monocyte-to-lymphocyte ratio(MLR)was related to worse outcome of CVD in patients undergoing PD.However,there is little evidence to show the association between MLR and cardiovascular events or mortality in patients with PD.And this study was conducted to evaluate the predictive value of MLR for cardiovascular events and mortality in patients with continuous ambulatory peritoneal dialysis(CAPD).SubjectsA total of 536 CAPD patients receiving maintenance PD by catheterization and regular CAPD for>3 months,during January 1,2010 to December 30,2018 in the Southern Medical University Zhujiang Hospital were enrolled in this study.MethodAll patients were followed up to June 1,2020,or reached the end point,or transfer to hemodialysis,or kidney transplantation.Demographic data and laboratory data of patients were collected as baseline data when they received CAPD for 1-3 months.During the follow-up period,new cardiovascular events,survival outcomes and specific causes of death were recorded.The primary endpoint was defined as the experienced of cardiovascular events,CVD death or all-cause death during the follow-up period.According to the median level of MLR(0.37),patients were divided into high MLR group and low MLR group,and the differences in baseline characteristics,incidence of cardiovascular events,CVD mortality,and all-cause mortality were compared between the two groups.Cox regression model or logistics regression model were used to evaluate the prognostic impact of MLR and other clinical factors on cardiovascular events,CVD mortality and all-cause mortality.Results1.There were statistically significant differences in age,gender,hypersensitive C-reactive protein(hsCRP),white blood cell(WBC)count,neutrophil count,monocyte count,lymphocyte count,serum creatinine(Scr),hemoglobin(Hb),red blood cell distribution width(RDW),and calcium(Ca)between the high MLR group and low MLR group.2.MLR was found to positively correlate with age,male,hsCRP,WBC count,neutrophil count,platelet(PLT)count,and Scr;and negatively correlate with Hb,Ca,and albumin.3.Kaplan-Meier survival curve suggested that the cumulative incidence of cardiovascular events in the high MLR group was significantly higher than that in the low MLR group.Univariate and multivariate cox regression analysis showed that high MLR level was independent risk factors for cardiovascular events.4.There was a significant difference in the incidence of cerebrovascular disease,heart disease and multiple cardiovascular events between the two groups.Logistics regression analysis showed that MLR was still an independent risk factor for cerebrovascular disease,heart disease and multiple cardiovascular events after adjusted logistics regression analyses.5.Comparison of baseline data between death group and survival group found that the MLR level of the death group was higher,especially in the CVD death group.6.Kaplan-Meier survival curve suggested that the survival rate and CVD survival rate of the high MLR group were significantly reduced.And high MLR level was still an independent risk factor for CVD death and all-cause death after adjusted cox regression analyses.7.Subgroup analysis showed that there was a significant difference in the cumulative CVD mortality between the high and low MLR groups in the subgroups of non-diabetic patients,patients with CVD history or without CVD history.But in the diabetic subgroup,the difference was not statistically significant.Conclusion1.In patients undergoing CAPD,MLR was positively related to age,hsCRP,WBC and Scr,and negatively related with Hb,Ca and albumin.2.High MLR level was independently associated with cardiovascular events in CAPD patients.High MLR can be used to predict the risk of cardiovascular events.3.High MLR level was a strong and independent risk fator for CVD and all-cause mortality in CAPD patients.