Role of neutrophil/lymphocyte ratio in prediction of disease progression in patients with stage-4 chronic kidney disease

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. NIL 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. Conclusion: Our results suggest that NIL 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.