title: Relationship between late arteriovenous fistula (AVF) stenosis and neutrophil-lymphocyte ratio (NLR) in chronic hemodialysis patients.
abstract: OBJECTIVE
  Primary cause of late arteriovenous fistula (AVF) dysfunction is venous stenosis as result of neointimal hyperplasia. The mechanism of AVF stenosis is not exactly understood. But inflammation is a contributing factor for development of AVF stenosis. Neutrophil-lymphocyte ratio (NLR) reflects systemic inflammation, and it was investigated in many diseases. The aim of this study was to investigate the relationship between NLR and AVF stenosis in chronic hemodialysis patients.
  
  
  METHODS
  Of 593 patients applied to the department of interventional radiology between January 2011 and November 2012, a total of 108 patients meeting the appropriate criteria were included in this study. All patients were assessed with Color Doppler ultrasonography and then digital subtraction angiography was used for the patients with abnormal results. Sixty-four patients were classified as patients with AVF stenosis (group 1) and 44 patients without AVF stenosis (group 2). Routine biochemical and complete blood count values measured six months ago were recorded for all patients.
  
  
  RESULTS
  Mean NLR (3.47 ± 0.46 vs. 2.27 ± 0.22; p < 0.001) was higher in group 1 compared to group 2, whereas high-density lipoprotein (HDL; 31.8 ± 12.6 mg/dL vs. 51.5 ± 11.9 mg/dL; p < 0.001) was lower in group 1. NLR level was correlated with degree of AVF stenosis (r = 0.625; p < 0.01). Receiver operating characteristic curve analysis showed that NLR (optimal-cut-off = 2.70) was a useful parameter in prediction of AVF stenosis (AUC = 0.893, sensitivity = 98.4% and specificity = 75%; p < 0.001). NLR level and HDL < 30 mg/dL in logistic regression analysis are independent predictors of AVF stenosis.
  
  
  CONCLUSIONS
  For hemodialysis patients with increased level of NLR and decreased level of HDL, regular monitoring with regard to the development of AVF stenosis may be beneficial. Our study suggests that the mechanism of AVF stenosis might have similarities to that of atherosclerosis.
authors.affiliation: Department of Internal Medicine, Section of Nephrology, School of Medicine, Turgut Ozal University , Ankara , Turkey .
authors.forename: Hakki
authors.initials: H
authors.lastname: Yilmaz
authors.forename: Alper
authors.initials: A
authors.lastname: Bozkurt
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Cakmak
authors.forename: Huseyin Tugrul
authors.initials: HT
authors.lastname: Celik
authors.forename: Mukadder Ayse
authors.initials: MA
authors.lastname: Bilgic
authors.forename: Nuket
authors.initials: N
authors.lastname: Bavbek
authors.forename: Ali
authors.initials: A
authors.lastname: Akcay
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D001166:Arteriovenous Shunt, Surgical; D001783:Blood Flow Velocity; D003251:Constriction, Pathologic; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging / Q000628:therapy*; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D012372:ROC Curve; D006435:Renal Dialysis; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color
keywords: AVF stenosis; Color Doppler ultrasonography; NLR; digital subtraction angiography; inflammation