Kidney Week

Abstract: FR-PO389

Association of Neutrophil-to-Lymphocyte Ratio with Atherosclerotic Cardiovascular Disease and Kidney Outcomes in CKD

Session Information

• Hypertension, CVD, and the Kidneys: Epidemiology
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Mahalwar, Gauranga, Cleveland Clinic, Cleveland, Ohio, United States

Gauranga Mahalwar, MBBS

• Chen, Zhengyi, University Hospitals, Cleveland, Ohio, United States

Zhengyi Chen, PhD

• Horwitz, Edward J., MetroHealth Medical Center, Cleveland, Ohio, United States

Edward J. Horwitz, MD

• Taliercio, Jonathan J., Cleveland Clinic, Cleveland, Ohio, United States

Jonathan J. Taliercio, DO, FASN

• Rahman, Mahboob, University Hospitals, Cleveland, Ohio, United States

Mahboob Rahman, MD, MBBS

• Dobre, Mirela A., University Hospitals, Cleveland, Ohio, United States

Mirela A. Dobre, MD, FASN, MPH

• Brateanu, Andrei, Cleveland Clinic, Cleveland, Ohio, United States

Andrei Brateanu, MD

Background

CKD is a highly inflammatory state that results in accelerated atherosclerotic cardiovascular disease (ASCVD). The neutrophil-to-lymphocyte ratio (NLR) is a known inflammatory biomarker related to ASCVD in the general population but is less studied in CKD. We aimed to assess the association between NLR and clinical events in CKD.

Methods

Serum NLR was measured at baseline in 5089 participants with CKD, enrolled in Chronic Renal Insufficiency Cohort (CRIC) study. The primary outcome was a composite incident ASCVD (myocardial infarction, stroke, peripheral arterial disease, and CVD mortality). Secondary outcomes were CKD progression (incident ESKD [either initiation of dialysis or kidney transplantation] or 50% eGFR decline), and all-cause mortality. Cox proportional hazards models were built to investigate the association between NLR tertiles and the time to occurrence of clinical outcomes.

Results

The mean age (SD) was 59.3 (10.8) years and 56% were female. Participants in the highest tertile of NLR were more likely to have diabetes, higher blood pressure, lower eGFR and higher proteinuria levels. Kaplan-Meier curves demonstrated a statistically significant association
between higher NLR tertile and clinical outcomes (Figure). In models adjusted for demographics, co-morbidities, medications, eGFR, proteinuria and C-reactive protein, compared to lowest tertile, participants in the highest NLR tertile were more likely to have incident ASCVD (HR 1.27 (1.1, 1.48), p=0.002), CKD progression (HR 1.25 (1.09, 1.44), p=0.002) and all-cause mortality (HR 1.29 (1.12, 1.47), p<0.001).

Conclusion

In a cohort of participants with CKD, elevated NLR levels were associated with a higher risk of ASCVD, progression of CKD and mortality independent of the conventional risk factors. Further research is needed to test whether incorporating NLR into existing risk prediction models would improve their accuracy and facilitate interventions in susceptible CKD patients.

Incidence of the primary ASCVD outcome, kidney events and all-cause mortality by baseline NLR