Neutrophil-lymphocyte ratio as a novel predictor of survival in chronic hemodialysis patients

Increased mortality rate in chronic hemodialysis (HD) patients is partly attributed to a chronic inflammatory state. Neutrophil-lymphocyte ratio (NLR), defined as the neutrophil count divided by lymphocyte count, is increasingly recognized as a marker of systemic inflammation, but its prognostic value in HD patients is unknown. The aim of this study was to assess NLR as a predictor of survival in this patient population. In this study incident chronic HD patients were stratified in tertiles of NLR based on measurements obtained 3 months after initiation of dialysis. Multivariable Cox regression was used to calculate the adjusted hazard ratios (HR) for NLR on all-cause survival. Subsequently, similar models were developed at years 2 and 3 to assess predictive value of NLR in prevalent patients. We studied 5,782 incident HD patients (mean ± SD age 62 ± 15 years, 55% male, 43% Black, 52% diabetic). The median (interquartile, (IQR)) NLR at 3 months was 3.0 (2.1 - 4.5). NLR in the highest tertile (NLR ≥ 3.9) was a significant predictor of all-cause mortality after an adjustment for demographic and clinical covariates was performed. These results were confirmed at years 2 and 3. Moreover, NLR is superior to total white blood cell (WBC) count for prediction of all-cause mortality in incident hemodialysis patients (are under the receiver operating characteristic (ROC) curve of 0.66 vs. 0.56). This study identifies NLR as a novel and robust predictor of all-cause mortality in incident and prevalent HD patients. NLR is an inexpensive and readily available marker that may help to identify HD patients who are at an increased risk of death.