The Relationship Between Neutrophil-lymphocyte Ratio And Depression In Maintenance Hemodialysis Patients

Objective: To investigate the occurring rate of depression in patients with chronic kidney disease(CKD)receiving maintenance hemodialysis,and to explore the relationship between neutrophil-lymphocyte ratio(NLR)and depression in maintenance hemodialysis patients.Methods: Two hundred and eighty-four CKD patients receiving regular hemodialysis treatment in the hemodialysis center of hunan provincial people’s hospital from January to December 2019 were selected.According to the inclusion and exclusion criteria,205 maintenance hemodialysis patients were included in this study.Collecting the general information(including sex,age,marriage,height,weight,education status,employment status,income,smoking and drinking habits,use of erythropoietin,hypertension,coronary heart disease,diabetes,protopathy)and biochemical markers [including serum creatinine(Scr),urea nitrogen(BUN),white blood cell(WBC),neutrophil(N),lymphocyte(L),red blood cells(RBC),hemoglobin(Hb),red blood cell distribution width(RDW),platelet(PLT),platelet distribution width(PDW),blood sugar(BS),albumin(Alb),prealbumin(PAB),total cholesterol(TC),triglyceride(TG),low density lipoprotein(LDL),high-density lipoprotein(HDL),free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH),serum ferritin(SF),serum calcium(Ca),serum phosphorus(P),parathyroid hormone(PTH)] about the subjects members.Calculating the neutrophils-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),body mass index(BMI),glomerular filtration rate(eGFR).Evaluating depression of hemodialysis patients by Hamilton depression scale(HAMD).All hemodialysis patients were divided into non-depressed group(<7 points)and depressed group(≥7points),and the depressed group was further divided into mild-depression group(7-17 points),moderate-depression group(18-24 points)and severe-depression group(>24 points).General and biochemical data of hemodialysis patients in the depressed group and the non-depressed group were compared,and the indicators with statistically significant differences were further compared in the mild,moderate and severe depression groups.Spearman correlation analysis was used to analyze the correlation between depression score and various indicators in hemodialysis patients.The independent risk factors of depression in hemodialysis patients were analyzed by binary Logistic regression.Receiver operating characteristic(ROC)curve analysis was performed to assess the value of NLR in predicting moderate and severe depression in hemodialysis patients,and to determine the cut-off level,sensitivity,and specificity.Results:1.In this study,the occurring rate of depression in maintenance hemodialysis patients was 66.34%,among which 64.7%,25% and10.29% were patients with mild,moderate and severe depression,respectively.2.In hemodialysis patients,the number of smoking,drinking as well as the level of neutrophils,NLR and total cholesterol in the depression group were significantly higher than those in the non-depressed group.The number of employed peoples,high-income peoples as well as the level of lymphocytes,hemoglobin and FT3 were significantly lower than those in the non-depressed group,with statistically significant differences(P<0.05).3.The level of NLR and neutrophil were significant different between the mild,moderate and severe depression groups.Further comparative analysis showed that the moderate and severe depression groups had significantly higher level of NLR and neutrophil than the mild depression group,and the severe depression group had significantly higher neutrophil level compared to the moderate depression group,the differences is statistically significant(P<0.05).4.Spearman correlation analysis revealed that depression score in hemodialysis patients was positively correlated with neutrophil(r=0.425,P<0.001),NLR(r=0.526,P<0.001),and total cholesterol(r=0.155,P<0.05),and negatively correlated with lymphocytes(r=-0.275,P<0.001),hemoglobin(r=-0.179,P<0.05),FT3(r=-0.181,P<0.01).5.In binary Logistic regression analysis,the increased NLR[Exp(B)=2.6,P<0.05],total cholesterol level[Exp(B)=1.548,P<0.05],and the decreased hemoglobin [Exp(B)=0.973,P<0.05],as well as the unemployment [Exp(B)=0.34,P<0.05] were independent risk factors for depression in maintenance hemodialysis patients.6.ROC curve analysis showed that the cut-off level of NLR to predict moderate and severe depression in hemodialysis patients was5.33[area under the curve 0.788(95% confidence interval 0.705-0.871,P<0.05),sensitivity 68.8%,and specificity 87.3%].Conclusion:1.Depression was common in maintenance hemodialysis patients and was associated with increased NLR level.The higher the NLR,the more severe the depression might be.2.NLR level was an independent risk factor for depression in hemodialysis patients.3.A NLR of 5.33 or higher might be an independent predictor of moderate and severe depression in hemodialysis patients.