Neutrophil-to-Lymphocyte Ratio as a Prognostic and Comparative Parameter in Hemodialysis Patients: A Cross-Sectional Study

Abstract

Background: Chronic kidney disease (CKD) is associated with complex hematological alterations, including lymphopenia, neutrophilia, and immune dysregulation with increased interest in neutrophil-to-lymphocyte ratio (NLR) which may act as a humble, practical prognostic and inflammatory marker. However, the intra-dialytic stability of NLR and the correlation between NLR and clinical outcomes in CKD patients remains inconsistent.

Methods: In this cross-sectional study, 200 patients with end-stage renal disease (ESRD) enduring maintenance hemodialysis (HD) at Aswan University Hospital were enrolled. For each patient, NLR was measured both pre and post dialysis session, allowing for paired comparisons. NLR values were subsequently examined according to anemic status, vascular access type, and mortality outcome. Independent predictors of mortality were then identified using logistic regression analysis.

Results: NLR remained stable across a single dialysis session (2.56 ± 1.58 pre-dialysis vs. 2.79 ± 2.65 post-dialysis, p = 0.126) and showed intermediate correlation between pre- and post-dialysis values (r = 0.583, R² = 0.340), more stable than its individual components, lymphocytes (R² = 0.325) and neutrophils (R² = 0.316). NLR did not vary significantly among anemic and non-anemic patients (2.56 ± 1.57 vs. 2.55 ± 1.74, p = 0.984). NLR was significantly higher amid non-survivors than survivors (3.17 ± 2.004 vs. 2.39 ± 1.39, p = 0.019). On multivariable analysis, an NLR > 4 was an self-regulating predictor of death (AOR = 3.200, ninty five percent CI: 1.243–8.237, p = 0.016), alongside a reduced left ventricular ejection fraction (EF) (<50%) (AOR = 2.941, ninty five percent CI: 1.193–7.250, p = 0.019). Overall mortality was 22%, predominantly cardiovascular and infectious.

Conclusion: NLR demonstrated stability across a single HD session and did not appear to be influenced by anemia status. However, it exhibited significant variation according to vascular access type and emerged as an sovereign predictor of death which supports the value of NLR as a simple, accessible prognostic sign in patients undergoing HD