Abstract
Background
Chronic kidney disease (CKD) being a gradually progressive disease involves declining renal function and systemic inflammation. The neutrophil-to-lymphocyte ratio (NLR), an emerging inflammatory marker, may serve as a valuable indicator of CKD severity and progression. The aim of this retrospective cross-sectional study was to investigate the association and variability of NLR across the stages of CKD.
Methods
The study took place at the Multan Institute of Kidney Diseases using data from the hospital's electronic records. The study duration was six months, from November 2022 to April 2023. CKD stages were assessed, and NLR was calculated. Statistical analysis was done to investigate the relationship between NLR and the different stages of CKD.
Results
The mean age of patients was 49 ± 16.9 years, out of which more than half were males. A statistically significant relationship (P-value < 0.05) was found between the NLR and disease severity across five stages of CKD. Additionally, the analysis of mean NLR values between different CKD stages indicated significant differences in NLR between Stage 5 and the other stages.
Conclusion
NLR is independently associated with CKD stage and may serve as a useful biomarker for assessing disease severity, particularly in advanced CKD. In resource-limited settings, NLR could facilitate risk stratification and support clinical decision-making for CKD patients.
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Data Availability
No datasets were generated or analysed during the current study.
Code Availability
Not applicable.
References
Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl. 2022;12(1):7–11. https://doi.org/10.1016/j.kisu.2021.11.003.
Couser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney Int. 2011;80(12):1258–70. https://doi.org/10.1038/ki.2011.368.
Shrestha N, Gautam S, Mishra SR, Virani SS, Dhungana RR. Burden of chronic kidney disease in the general population and high-risk groups in South Asia: a systematic review and meta-analysis. PLoS ONE. 2021;16(10):e0258494. https://doi.org/10.1371/journal.pone.0258494.
Zahorec R. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy. 2021;122(7):474–88. https://doi.org/10.4149/BLL_2021_078.
Raj DS, Pecoits-Filho R, Kimmel PL. Chapter 17 - Inflammation in Chronic Kidney Disease. In: Kimmel PL, Rosenberg ME, editors. Chronic Renal Disease. San Diego: Academic Press; 2015;199–212. https://doi.org/10.1016/B978-0-12-411602-3.00017-2
Mihai S, Codrici E, Popescu ID, Enciu AM, Albulescu L, Necula LG, et al. Inflammation-Related Mechanisms in Chronic Kidney Disease Prediction, Progression, and Outcome. J Immunol Res. 2018;2018:2180373. https://doi.org/10.1155/2018/2180373.
Rapa SF, Di Iorio BR, Campiglia P, et al. Inflammation and oxidative stress in chronic kidney disease-potential therapeutic role of minerals, vitamins and plant-derived metabolites. Int J Mol Sci. 2019. https://doi.org/10.3390/ijms21010263.
Lee TW, Bae W, Choi J, Bae E, Jang HN, Chang SH, et al. The neutrophil-to-lymphocyte ratio may indicate when to start hemodialysis. Ren Fail. 2022;44(1):1401–8. https://doi.org/10.1080/0886022X.2022.2110894.
Yuan Q, Wang J, Peng Z, Zhou Q, Xiao X, Xie Y, et al. Neutrophil-to-lymphocyte ratio and incident end-stage renal disease in Chinese patients with chronic kidney disease: results from the Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE). J Transl Med. 2019;17(1):86. https://doi.org/10.1186/s12967-019-1808-4.
Kidney Disease: Improving Global Outcomes (KDIGO) Anemia Work Group. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney Int Suppl. 2012;2:279–335
Burtis CA, Bruns DE. Reference information for the clinical laboratory. In: Tietz fundamentals of clinical chemistry and molecular diagnostics. 7th ed. Elsevier Health Sciences; 2014. p. 960.
Bain BJ, Bates I, Laffan MA. Reference ranges and normal values. In: Dacie and lewis practical haematology. 12th ed. Elsevier Health Sciences; 2016. p. 11.
Hoffbrand AV, Chowdary P, Collins G, Loke J. Erythropoiesis and general aspects of anaemia. In: Hoffbrand's essential haematology. 9th ed. John Wiley & Sons; 2024. p. 21.
Yilmaz G, Sevinc C, Ustundag S, Yavuz YC, Hacıbekiroglu T, Hatipoglu E, et al. The relationship between mean platelet volume and neutrophil/lymphocyte ratio with inflammation and proteinuria in chronic kidney disease. Saudi J Kidney Dis Transpl. 2017;28(1):90–4. https://doi.org/10.4103/1319-2442.198152.
Tonyali S, Ceylan C, Yahsi S, Karakan MS. Does neutrophil to lymphocyte ratio demonstrate deterioration in renal function? Ren Fail. 2018;40(1):209–12. https://doi.org/10.1080/0886022X.2018.1455590.
Toori KU, Qureshi MA, Chaudhry A, Safdar MF. Neutrophil to lymphocyte ratio (NLR) in COVID-19: a cheap prognostic marker in a resource constraint setting. Pak J Med Sci. 2021;37(5):1435–9. https://doi.org/10.12669/pjms.37.5.4194.
Evlice A, Şanlı ZS, Boz PB. The importance of vitamin-D and neutrophil-lymphocyte ratio for Alzheimer’s disease. Pak J Med Sci. 2023;39(3):799–803. https://doi.org/10.12669/pjms.39.3.7024.
Solak Y, Yilmaz MI, Sonmez A, Saglam M, Cakir E, Unal HU, et al. Neutrophil to lymphocyte ratio independently predicts cardiovascular events in patients with chronic kidney disease. Clin Exp Nephrol. 2013;17(4):532–40. https://doi.org/10.1007/s10157-012-0728-x.
Gangaiah Y, Nalini AR. Inflammatory markers in chronic renal diseases stages 1–4. Int J Acad Med Pharm. 2025;7(1):797–800. https://doi.org/10.47009/jamp.2025.7.1.157.
Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med. 2012;5(1):2. https://doi.org/10.1186/1755-7682-5-2.
Yoshitomi R, Nakayama M, Sakoh T, Fukui A, Katafuchi E, Seki M, et al. High neutrophil/lymphocyte ratio is associated with poor renal outcomes in Japanese patients with chronic kidney disease. Ren Fail. 2019;41(1):238–43. https://doi.org/10.1080/0886022X.2019.1595645.
Zhao W-M, Tao S-M, Liu G-L. Neutrophil-to-lymphocyte ratio in relation to the risk of all-cause mortality and cardiovascular events in patients with chronic kidney disease: a systematic review and meta-analysis. Ren Fail. 2020;42(1):1059–66. https://doi.org/10.1080/0886022X.2020.1832521.
Okyay GU, İnal S, Öneç K, Er RE, Paşaoğlu Ö, Paşaoğlu H, et al. Neutrophil to lymphocyte ratio in evaluation of inflammation in patients with chronic kidney disease. Ren Fail. 2013;35(1):29–36. https://doi.org/10.3109/0886022X.2012.734429.
Ellulu MS, Patimah I, Khaza’ai H, et al. Obesity and inflammation: the linking mechanism and the complications. Arch Med Sci. 2017;13(4):851–63. https://doi.org/10.5114/aoms.2016.58928.
Teng TS, Ji AL, Ji XY, Li YZ. Neutrophils and Immunity: From Bactericidal Action to Being Conquered. J Immunol Res. 2017;2017:9671604. https://doi.org/10.1155/2017/9671604.
Andrade-Oliveira V, Foresto-Neto O, Watanabe IKM, Zatz R, Câmara NOS. Inflammation in renal diseases: new and old players. Front Pharmacol. 2019;10:1192. https://doi.org/10.3389/fphar.2019.01192.
Heerspink HJL, De Zeeuw D. Novel anti-inflammatory drugs for the treatment of diabetic kidney disease. Diabetologia. 2016;59(8):1621–3. https://doi.org/10.1007/s00125-016-4030-4.
Zheng L, Zhang J, Yuan X, Tang J, Qiu S, Peng Z, et al. Fluorofenidone attenuates interleukin-1β production by interacting with NLRP3 inflammasome in unilateral ureteral obstruction. Nephrology. 2018;23(6):573–84. https://doi.org/10.1111/nep.13062.
Alberts B, Johnson A, Lewis J, Raff M, Roberts K, Walter P. Lymphocytes and the cellular basis of adaptive immunity. London, England: Garland Science; 2002.
Buonacera A, Stancanelli B, Colaci M, Malatino L. Neutrophil to lymphocyte ratio: an emerging marker of the relationships between the immune system and diseases. Int J Mol Sci. 2022. https://doi.org/10.3390/ijms23073636.
Lee H, Kim I, Kang BH, Um SJ. Prognostic value of serial neutrophil-to-lymphocyte ratio measurements in hospitalized community-acquired pneumonia. PLoS ONE. 2021;16(4):e0250067. https://doi.org/10.1371/journal.pone.0250067.
Wagdy S, Sobhy M, Loutfi M. Neutrophil/lymphocyte ratio as a predictor of in-hospital major adverse cardiac events, new-onset atrial fibrillation, and no-reflow phenomenon in patients with ST elevation myocardial infarction. Clin Med Insights Cardiol. 2016;10:19–22. https://doi.org/10.4137/CMC.S35555.
Huang J, Dahl DM, Dong L, Liu Q, Cornejo K, Wang Q, et al. Preoperative Neutrophil-to-Lymphocyte Ratio and Neutrophilia Are Independent Predictors of Recurrence in Patients with Localized Papillary Renal Cell Carcinoma. Biomed Res Int. 2015;2015:891045. https://doi.org/10.1155/2015/891045.
Luo Y, She DL, Xiong H, Fu SJ, Yang L. Pretreatment neutrophil to lymphocyte ratio as a prognostic predictor of urologic tumors: a systematic review and meta-analysis. Medicine (Baltimore). 2015;94(40):e1670. https://doi.org/10.1097/MD.0000000000001670.
Neuen BL, Leather N, Greenwood AM, Gunnarsson R, Cho Y, Mantha ML. Neutrophil-lymphocyte ratio predicts cardiovascular and all-cause mortality in hemodialysis patients. Ren Fail. 2016;38(1):70–6. https://doi.org/10.3109/0886022X.2015.1104990.
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Z.R., A.T., M.Z. and F.Z.T. The first draft of the manuscript was written by Z.R. and A.T., and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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The study performed involving human participants was in accordance with the ethical standards of the Ethical Review Committee of Indus Hospital and Health Network (IHHN_IRB_2023_05_038) at which the study was conducted and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Rasool, Z., Tasneem, A., Zubair, M. et al. Shedding Light on NLR Dynamics: A Journey Through CKD Stages. SN Compr. Clin. Med. 7, 297 (2025). https://doi.org/10.1007/s42399-025-02066-0
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DOI: https://doi.org/10.1007/s42399-025-02066-0