title: Role of neutrophil/lymphocyte ratio in prediction of disease progression in patients with stage-4 chronic kidney disease.
abstract: BACKGROUND
  Chronic kidney disease (CKD) tends to progress to end-stage renal disease without any intervention. Neutrophil/lymphocyte (N/L) ratio may be indicative of an underlying inflammatory state. We aimed to investigate the role of N/L ratio for prediction of progression to dialysis in patients with stage 4 CKD.
  
  
  METHODS
  We included 105 patients with stage 4 CKD in the study. All patients were followed up from the first admission to dialysis. N/L ratio was measured during follow-up. Patients were divided into two groups as baseline N/L (N/Lb) ratio < 3 and N/Lb ratio =3 and rapid progression was defined as > 5 mL/minute/year loss of creatinine clearance and slow progression as < 5 mL/minute/year.
  
  
  RESULTS
  Patients with N/L ratio =3 demonstrated high progression rate compared to patients who had N/L ratio <3 (2.6 ± 1.6 and 5.4 ± 3.3, P<.001). hs-CRP levels were higher in patients who had rapid progression (5.6 ± 3.0 and 20.2 ± 10.6, P<.001). The sensitivity and specificity of N/Lb were 79% and 69%, respectively, when the cutoff level was accepted as N/L ratio =3 for determining rapid progression. Furthermore, patients with a high N/Lb ratio had worse prognosis and significantly faster progression to the dialysis compared with those with a low N/L ratio.
  
  
  CONCLUSIONS
  Our results suggest that N/L ratio may predict the progression rate of stage 4 chronic kidney disease to dialysis. It is an easily accessible and useful marker for monitoring CKD patients in clinical practice.
authors.affiliation: Department of Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey. iikocyigit@gmail.com
authors.forename: Ismail
authors.initials: I
authors.lastname: Kocyigit
authors.forename: Eray
authors.initials: E
authors.lastname: Eroglu
authors.forename: Aydin
authors.initials: A
authors.lastname: Unal
authors.forename: Murat Hayri
authors.initials: MH
authors.lastname: Sipahioglu
authors.forename: Bulent
authors.initials: B
authors.lastname: Tokgoz
authors.forename: Oktay
authors.initials: O
authors.lastname: Oymak
authors.forename: Cengiz
authors.initials: C
authors.lastname: Utas
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney; D016015:Logistic Models; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology*; D011237:Predictive Value of Tests; D011379:Prognosis; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; D003404:Creatinine