Relationship Between Neutrophil-lymphocyte Ratio And Abdominal Aortic Calcification In Non-dialytic Patients With Chronic Kidney Disease Stage 3-5

Objective:To analyze the risk factors of abdominal aortic calcification(AAC)in patients with chronic kidney disease(CKD)who are not on dialysis at stage 3-5,and to explore the predictive value of neutrophil-lymphocyte ratio(NLR)for abdominal AAC.Methods:This study was a cross-sectional survey.From October 2017 to May 2018,181 cases of non-dialysis patients with CKD stage 3-5 in the department of nephrology of the second affiliated hospital of anhui medical university were selected.Relevant demographic characteristics,primary disease,medication,laboratory examination and other relevant data were collected,and the incidence of AAC in patients with abdominal radiography was examined.According to the presence or absence of AAC,patients were divided into calcification group and non-calcification group.Binary Logistic regression analysis was performed to analyze the risk factors affecting the occurrence of AAC.ROC was used to explore the predictive value of NLR for AAC.Results:Among 181 patients with CKD stage 3-5 non-dialysis,63 patients(34.8%)in the abdominal aortic calcification group and 118 patients(65.2%)in the non-calcification group.The NLR level in the calcified group was significantly higher than that in the non-calcified group[3.8(2.8,5.3)and 2.5(1.9,3.2),P<0.001],and the mean age was more than 10.6 years[(62.3 13.8)and(51.7 12.7),P<0.001].Hs-CRP,corrected calcium,BNP levels,pulse pressure difference,and diabetes prevalence in AAC group were all higher than those in non-calcified group(P<0.05),while albumin and calcium-phosphorus product levels were significantly lower than those in non-calcified group(P<0.05).In Spearman analysis,AAC was positively correlated with age(r_s=0.365,P<0.001),diabetes(r_s=0.279,P<0.001),NLR(r_s=0.468,P<0.001),Hs-CRP(r_s=0.221,P=0.017),corrected calcium(r_s=0.174,P=0.045),BNP(r_s=0.272,P=0.006),diastolic blood pressure(r_s=-0.186,P=0.014),and calcium phosphorus product(r_s=-0.151,P=0.044)and albumin(r_s=-0.202,P=0.009)were negatively correlated.Binary Logistic regression analysis showed that advanced age(OR=8.898,P=0.008),high hs-crp(OR=5.352,P=0.038)and NLR>3.74(OR=33.734,P=0.019)were independent risk factors for AAC.ROC curve analysis showed that the area under the curve was 0.829(95%CI 0.767~0.890,P<0.001),significantly higher than that under the separate analysis of NLR(0.780,95%CI 0.706~0.854,P<0.001)and age(0.721,95%CI 0.641~0.801,P<0.001)when the combined index of NLR and age predicted the occurrence of AAC in non-dialysis patients with stage 3-5 CKD.Conclusion:CKD patients with stage 3-5 non-dialysis have a high incidence of AAC,old age and high level NLR are risk factors for the occurrence of AAC and have a good predictive value for AAC in CKD patients with stage 3-5 non-dialysis,and joint index of the NLR and age more value for the forecast of AAC.So it should be paid attention to age and level of NLR in the clinical work in patients,fully assess vascular calcification in patients with risk,and according to the results of the corresponding clinical intervention as soon as possible.