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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2017  |  Volume : 28  |  Issue : 1  |  Page : 90-94
The relationship between mean platelet volume and neutrophil/lymphocyte ratio with inflammation and proteinuria in chronic kidney disease


1 Department of Nephrology, Faculty of Medicine, Fatih University, Istanbul, Turkey
2 Department of Nephrology, Erzurum Regional Research and Training Hospital, Erzurum, Turkey
3 Department of Nephrology, Trakya University Faculty of Medicine, Edirne, Turkey
4 Department of Hematology, Edirne State Hospital, Edirne, Turkey
5 Department of Endocrinology, Edirne State Hospital, Edirne, Turkey
6 Department of Internal Medicine, Trakya University Faculty of Medicine, Edirne, Turkey

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Date of Web Publication12-Jan-2017
 

   Abstract 

Atherosclerosis, which develops as a result of inflammation, is the most important cause of morbidity and mortality in chronic kidney disease (CKD). In this study, we investigated the relationship of mean platelet volume (MPV) and neutrophil/lymphocyte ratio (NLR) with inflammation and proteinuria in patients with CKD Stage 3-4. Healthy individuals who applied to nephrology clinic for checkup purposes acted as controls. Fifty-three patients and 30 healthy controls were included in the study. Patients with diabetes mellitus, active infection, malignancy, and coronary artery disease were excluded from the study. Biochemistry values and hemograms were recorded for all patients and for control group. NLR was calculated. The relationship between MPV/NLR and protein, fibrinogen, and proteinuria was evaluated. Our study showed a statistically significant difference between CKD group and healthy control (HC) group in uric acid, fibrinogen, C-reactive protein, and NLR values (P <0.01, P <0.01, P = 0.01, P <0.01, respectively). No statistically significant difference was found between CKD and HC groups for MPV (P = 0.307). Correlation analysis revealed a statistically significant relationship between NLR and creatinine (P <0.00, r = 0.571), uric acid (P <0.00, r = 0.436), glomerular filtration rate (P <0.00, r = −0.418), 24 h urine protein (P = 0.004, r = 0.311), and 24 h urine microalbumin (P = 0.001, r = 0.354). A statistically significant relationship was detected between MPV and platelet count (P <0.001, r = −0.422), age (P = 0.004, r = −0.312), uric acid (P = 0.04, r = −0.226), and fibrinogen (P = 0.023, r = −0.249). Whereas, a statistically significant relationship was detected between NLR and microalbuminuria/proteinuria, there was no statistically significant relationship between MPV and microalbuminuria/proteinuria. Our study showed that the NLR is high in CKD group and is correlated with uric acid and proteinuria, which are known to be associated with atherosclerosis, in patients with CKD. NLR may be a determinant of inflammation and atherosclerosis in patients with CKD.

How to cite this article:
Yilmaz G, Sevinc C, Ustundag S, Yavuz YC, Hacıbekiroglu T, Hatipoglu E, Baysal M. The relationship between mean platelet volume and neutrophil/lymphocyte ratio with inflammation and proteinuria in chronic kidney disease. Saudi J Kidney Dis Transpl 2017;28:90-4

How to cite this URL:
Yilmaz G, Sevinc C, Ustundag S, Yavuz YC, Hacıbekiroglu T, Hatipoglu E, Baysal M. The relationship between mean platelet volume and neutrophil/lymphocyte ratio with inflammation and proteinuria in chronic kidney disease. Saudi J Kidney Dis Transpl [serial online] 2017 [cited 2017 Jul 20];28:90-4. Available from: http://www.sjkdt.org/text.asp?2017/28/1/90/198152

   Introduction Top


Chronic kidney disease (CKD) is a chronic inflammatory process. Atherosclerosis, which develops as a result of inflammation, is the most important cause of morbidity and mortality in CKD.[1] Cardiovascular mortality risk due to atherosclerosis is 10-20-fold higher in CKD patients as compared to general population.[2] In addition to conventional risk factors, CKD has nonconventional risk factors that accelerate atherosclerosis.[3] Nonconventional risk factors include inflammation and thrombogenic factors. In addition to known conventional indications of inflammation such as Creactive protein (CRP), fibrinogen, erythrocyte sedimentation rate, several interleukins and tumor necrotizing factor alpha, several recent studies have shown that mean platelet volume (MPV) and neutrophil/lymphocyte ratio (NLR) are also increased during inflammation and may be associated with poorer prognosis in CKD.[4] ,[5] Use of MPV and NLR as indications of inflammation is very valuable as they can be evaluated by a simple blood count. Therefore, in our study, we investigated NLR and MPV and their relationship to inflammation and proteinuria in patients with CKD.


   Materials and Methods Top


Fifty-three patients with CKD in Stages 3 and 4 between the ages of 19-65 years with glomerular filtration rate (GFR) values of 15-59 mL/min/1.73 m2 and body mass index (BMI) <35 kg/m2 were included in the study. Patients with acute illness, diabetes, malignancy, and cerebrovascular disease were excluded from the study. Thirty healthy individuals who applied for checkup purposes were used as controls. They all had estimated GFR values above 60 mL/min/1.73 m2 and BMI <35 kg/m2. GFR of patients with CKD was calculated using CKD-epidemiology collaboration formula.

Age, gender, hemogram, urea, creatinine, uric acid, fibrinogen, CRP, 24 h urine protein, and microalbumin values were retrieved from the medical records of patients and control subjects. Statistical Package for the Social Science (SPSS) software version 20.0 (SPSS Inc, Chicago, IL, USA) was used for statistical analysis. For comparison of groups and data, Kolmogorov-Smirnov test was used to check the suitability of data to normal distribution. For investigation of difference between the parametric data of two groups, Student's t-test was used if data were suitable to normal distribution and Mann-Whitney U-test was used in case of nonsuitability of data to normal distribution. The difference between the categorical data of two groups was investigated using Chi-square test. For correlation analysis, Pearson's correlation test was used when data were suitable to normal distribution, and Spearman's correlation test was used when at least one data was not suitable to normal distribution.


   Results Top


Demographic and biochemical data of study group are provided in [Table 1]. Mean ages of the patients in CKD and healthy control (HC) groups were 47.1 ± 8.9 and 43.4 ± 8.9 years, respectively (P not significant). Percentages of the female subjects in control and CKD groups were 80% and 66%, respectively (P not significant).
Table 1. Demographic and biochemical data of study group.

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Our study showed a statistically significant difference between CKD group and HC group in urea, creatinine, microalbuminuria, proteinuria, uric acid, fibrinogen, CRP, and NLR values (P <0.01, P <0.01, P = 0.01, P <0.01, P <0.01, P <0.01, P = 0.01, P <0.01, respectively). Although the MPV values were lower in CKD group than control group, difference was not statistically significant (P = 0.307).

Positive correlation was found between NLR and proteinuria (P = 0.004, r = 0.311), micro-albuminuria (P = 0.001, r = 0.354), creatinine (P <0.001, r = 0.424), and uric acid (P <0.001, r = 0.436), whereas a negative correlation was detected between NLR and GFR (P <0.001, r = −0.418) ([Table 2] and [Figure 1]).
Figure 1. Correlation between NLR, GFR and proteinuria.
NLR: Neutrophil/lymphocyte ratio, GFR: Glomerular filtration rate.


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Table 2. Multiple correlations between NLR and other data.

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A negative correlation was detected between MPV and platelet count (P <0.001, r = −0.422), age (P = 0.004, r = −0.312), uric acid (P = 0.040, r = −0.226), and fibrinogen (P = 0.023, r = −0.249). No statistically significant relationship was detected between MPV and microalbuminuria/proteinuria (P = 0.118, P = 0.370).


   Discussion Top


Atherosclerosis, which develops as a result of inflammation, is the most important cause of mortality in CKD. Inflammation begins during early stages of CKD.[1] Neutrophil counts are increased, whereas lymphocyte counts are decreased during inflammation and recent studies have emphasized that NLR could be used as an indication for inflammation. We evaluated NLR and MPV. In patients with Stage 3 and 4 CKD, We also evaluated CRP and fibrinogen as indicators of inflammation in these patients.

Other studies showed that NLR is increased in inflammation in cardiovascular disorders and can be used as an indicator of prognosis.[6] ,[7] Ghaffari et al showed that NLR is a determinant for prognosis in myocardial infarction and for risk of postinfarction major events.[8] Studies in patients with malignancies as well as cardiovascular disorders revealed that NLR and lifespan are correlated.[9] In our study, we also determined that NLR is significantly higher in patients with CKD compared to healthy individuals and NLR is increased as the stage of kidney disease progressed.

NLR has also been shown to correlate with proteinuria.[10] Another study in 80 patients who were newly diagnosed with type 2 diabetes mellitus revealed a relationship between NLR and 24 h urine protein excretion.[11] We included nondiabetic patients in our study and showed a positive relationship between NLR and proteinuria/microalbuminuria.

Platelets play an important role in the pathogenesis of vascular disorders. Larger platelets are more active and release more prothrombotic factors.[12] Increased MPV is considered as an independent risk factor for cardiocerebrovascular disorders.[13] ,[14] Ju et al reported that there is a negative linear correlation between GFR and MPV in patients with chronic kidney failure, but that MPV is higher in patients with cardiovascular or cerebrovascular disorders.[4] Bilen et al, in result of their study, conducted with 200 patients with CKD (50 kidney transplantation, 50 hemodialysis, 50 peritoneal dialysis, 50 and Stage 3-4 CKD), reported that there are no differences between the groups for MPV.[15]

In our study, we could not detect a statistically significant difference between CKD patients and healthy controls for MPV but observed a negative correlation between glomerular filtration rate and MPV. Several studies have found that MPV is associated with proteinuria.[16] We could not detect a statistically significant relationship between MPV and proteinuria.


   Conclusion Top


Our study found that NLR is significantly higher in CKD and is associated with proteinuria. MPV was lower in patients with CKD compared to healthy individuals, but this was not statistically significant. MPV was also not found to be associated with proteinuria. In light of these data, it can be concluded that NLR could be used as an indication of inflammation and proteinuria in CKD.

Conflict of interest: None declared.

 
   References Top

1.
Tonelli Tonelli M, Wiebe N, Culleton B, et al. Chronic kidney disease and mortality risk: A systematic review. J Am Soc Nephrol 2006;17:2034-47.  Back to cited text no. 1
    
2.
Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998;32:112-9.  Back to cited text no. 2
    
3.
Sarnak MJ, Levey AS. Cardiovascular disease and chronic renal disease: a new paradigm. Am J Kidney Dis 2000;35 4 Suppl 1:S117-31.  Back to cited text no. 3
    
4.
Ju HY, Kim JK, Hur SM, et al. Could mean platelet volume be a promising biomarker of progression of chronic kidney disease? Platelets 2015;26:143-7.  Back to cited text no. 4
    
5.
Kocyigit I, Eroglu E, Unal A, et al. Role of neutrophil/lymphocyte ratio in prediction of disease progression in patients with stage-4 chronic kidney disease. J Nephrol 2013;26:358-65.  Back to cited text no. 5
    
6.
Duffy BK, Gurm HS, Rajagopal V, Gupta R, Ellis SG, Bhatt DL. Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. Am J Cardiol 2006;97:993-6.  Back to cited text no. 6
    
7.
Okyay GU, Inal S, Oneç K, et al. Neutrophil to lymphocyte ratio in evaluation of inflammation in patients with chronic kidney disease. Ren Fail 2013;35:29-36.  Back to cited text no. 7
    
8.
Ghaffari S, Nadiri M, Pourafkari L, et al. The predictive value of total neutrophil count and neutrophil/lymphocyte ratio in predicting ýn-hospital mortality and complications after STEMI. J Cardiovasc Thorac Res 2014;6:35-41.  Back to cited text no. 8
    
9.
Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 2005;91:181-4.  Back to cited text no. 9
    
10.
Binnetoglu E, Sengül E, Halhalli G, Dindar S, Sen H. Is neutrophil lymphocyte ratio an indicator for proteinuria in chronic kidney disease? J Clin Lab Anal 2014;28:487-92.  Back to cited text no. 10
    
11.
Afsar B. The relationship between neutrophil lymphocyte ratio with urinary protein and albumin excretion in newly diagnosed patients with type 2 diabetes. Am J Med Sci 2014;347:217-20.  Back to cited text no. 11
    
12.
Pereg D, Berlin T, Mosseri M. Mean platelet volume on admission correlates with impaired response to thrombolysis in patients with ST-elevation myocardial infarction. Platelets 2010;21:117-21.  Back to cited text no. 12
    
13.
Güldiken B, Özkan H, Kabayel L. Mean platelet volume and peripheral blood count response in acute ýschemic stroke. Trakya Univ Týp Fak Derg 2008;2:130-5.  Back to cited text no. 13
    
14.
Slavka G, Perkmann T, Haslacher H, et al. Mean platelet volume may represent a predictive parameter for overall vascular mortality and ischemic heart disease. Arterioscler Thromb Vasc Biol 2011;31: 1215-8.  Back to cited text no. 14
    
15.
Bilen Y, Cankaya E, Keles M, et al. Does decreased mean platelet volume predict inflammation in chronic renal failure, dialysis, and transplanted patients? Ren Fail 2014;36:69-72.  Back to cited text no. 15
    
16.
Sakalli H, Kal O. Mean platelet volume as a potential predictor of proteinuria and amyloidosis in familial Mediterranean fever. Clin Rheumatol 2013;32:1185-90.  Back to cited text no. 16
    

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Correspondence Address:
Can Sevinc
Department of Nephrology, Erzurum Regional Research and Training Hospital, Erzurum
Turkey
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DOI: 10.4103/1319-2442.198152

PMID: 28098108

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