title: Neutrophil to lymphocyte ratio independently predicts cardiovascular events in patients with chronic kidney disease.
abstract: BACKGROUND
  Increased inflammation is common in patients with chronic kidney disease (CKD) and is associated with increased adverse cardiovascular events (CVE). Neutrophil-to-lymphocyte ratio (NLR) was used to predict survival in patients with acute coronary syndrome. We aimed to evaluate predictive ability of NLR in CKD patients.
  
  
  METHODS
  225 subjects with stage 3-5 CKD were followed for a mean of 39 months. Fatal and nonfatal CVE were recorded during this period. NLR at baseline was determined from complete blood count differential. Endothelial dysfunction (flow-mediated dilation, FMD), hsCRP and insulin resistance were determined. We investigated if NLR could predict development of fatal and nonfatal CVE. We also looked at how NLR and its individual components change across CKD stages and whether NLR is related to CRP, insulin resistance and endothelial dysfunction.
  
  
  RESULTS
  There were 70, 74 and 81 patients in groups of CKD stage-3, stage-4 and stage-5, respectively. Median NLR was 2.81. NLR showed a significant increase from stage 3 to stage 5. NLR was inversely associated with FMD independent of hsCRP. 14 fatal and 52 nonfatal CVE occurred during follow-up period. NLR could predict composite CVE independent of insulin resistance and hsCRP. Increased NLR over 2.81 was related to a significantly decreased survival time (log-rank Chi-square = 14.833, P < 0.0001). A cutoff value for NLR ≥3.76 could predict development of composite CVE with 80.3 % sensitivity and 91.8 % specificity.
  
  
  CONCLUSIONS
  NLR is independently related to endothelial dysfunction and could predict composite cardiovascular endpoints independent of traditional confounding factors in patients with moderate to severe CKD.
authors.affiliation: Department of Nephrology, Meram Tip Fakultesi, Hemodiyaliz Sekreterliği, Selcuk University, Meram School of Medicine, Meram, Konya, 42090, Turkey. yalcinsolakmd@gmail.com
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Solak
authors.forename: Mahmut Ilker
authors.initials: MI
authors.lastname: Yilmaz
authors.forename: Alper
authors.initials: A
authors.lastname: Sonmez
authors.forename: Mutlu
authors.initials: M
authors.lastname: Saglam
authors.forename: Erdinc
authors.initials: E
authors.lastname: Cakir
authors.forename: Hilmi Umut
authors.initials: HU
authors.lastname: Unal
authors.forename: Mahmut
authors.initials: M
authors.lastname: Gok
authors.forename: Kayser
authors.initials: K
authors.lastname: Caglar
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Oguz
authors.forename: Mujdat
authors.initials: M
authors.lastname: Yenicesu
authors.forename: Murat
authors.initials: M
authors.lastname: Karaman
authors.forename: Seyit Ahmet
authors.initials: SA
authors.lastname: Ay
authors.forename: Abduzhappar
authors.initials: A
authors.lastname: Gaipov
authors.forename: Suleyman
authors.initials: S
authors.lastname: Turk
authors.forename: Abdulgaffar
authors.initials: A
authors.lastname: Vural
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Carrero
mesh_terms: D000328:Adult; D000368:Aged; D001916:Brachial Artery / Q000000981:diagnostic imaging; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications; D012680:Sensitivity and Specificity; D014463:Ultrasonography