The Association Of Neutrophil-To-Lymphocyte Ratio And Arterial Stiffness In Patients With Chronic Kidney Disease

Objective: Cardiovascular disease is one of the common serious complications of chronic kidney disease(CKD).Arterial stiffness,which can independently predict the occurrence of cardiovascular disease,has become an unconventional risk indicator for the effective assessment of cardiovascular events in CKD patients with CKD.Emerging evidence suggests blood neutrophil-to-lymphocyte ratio(NLR)as a new inflammatory index,yet the relationship between NLR and arterial stiffness is not clear in patients with CKD.The purpose of this study is to examine the association between blood NLR and arterial stiffness,assessed by brachial ankle pulse wave velocity(baPWV),in patients with CKD.Methods: A total of 238 patients with CKD in the Second Hospital of Ningbo were classified into 5 CKD stages(CKD 1 to 5)according to the evaluation of glomerular filtration rate(eGFR,EPI formula).The clinical data were collected and the baPWV levels of the patients were measured.The relationship between NLR and baPWV was analyzed by single factor correlation analysis and multiple linear regression analysis.Results: The mean(SD)age of patients with CKD was 59.25 + 17.11 years old.This study included 127 men and 111 women.Among these patients,113 had chronic glomerulonephritis(47.5%),50 had diabetic nephropathy(21%),45 had hypertensive nephropathy(18.9%),and 30 had other nephropathy diseases(12.6%);according to CKD stages;44 had CKD1,31 had CKD2,had 51 CKD3,29 had CKD4,and 83 had CKD5.Levels of total white blood cells or neutrophils did not show significant difference across CKD stage groups(P>0.05),while lymphocyte levels significantly decreased with increased CKD stages(P<0.05).Levels of baPWV were significantly different across CKD stage groups,and significantly increased with decreased renal function(P < 0.01).Pearson correlation analysis showed that baPWV levels were inversely correlated with lymphocyte levels(r=-0.27,P<0.01)and positively correlated with blood NLR(r=0.24,P < 0.01),but was not correlated with levels of total white blood cells(r=-0.04,P=0.56)or neutrophils(r=-0.05,P=0.47).Multiple linear regression analysis showed that blood NLR was significantly associated with baPWV in patients with CKD(beta =35.34,t=2.50,P=0.01),adjusting for age andsex.However,the association did not remain significant after further adjustment for diabetes,blood pressure,blood lipids and renal function(beta =11.37,t=0.85,P=0.40).Conclusion: This study indicates a suggestive association between blood NLR and arterial stiffness in patients with CKD,and future studies with larger sample sizes are needed to validate our findings.In addition,further studies are warranted to examine the potential causal relationship between blood NLR and arterial stiffness and whether anti-inflammatory treatment can improve arterial stiffness in patients with CKD.