Analysis of Neutrophil-to-lymphocyte and Platelet-to-lymphocyte Ratios As Inflammatory Biomarkers in Chronic Kidney Disease: Impact of Parathyroidectomy

Overview

Journal J Bras Nefrol

Specialty Nephrology

Date 2024 Apr 9

PMID 38591824

Authors

Andre Kakinoki Teng

Eduardo Jorge Duque

Shirley Ferraz Crispilho

Wagner Domingues

Vanda Jorgetti

Luciene M Dos Reis

Rosilene M Elias

Rosa Maria Affonso Moyses

Affiliations

Soon will be listed here.

Abstract

Introduction: Secondary hyperparathyroidism (SHPT) is one of the causes for inflammation in CKD. We assessed the impact of parathyroidectomy (PTX) on neutrophil-to-lymphocyte (N/L) and platelet-to-lymphocyte (P/L) ratios in SHPT patients.

Methods: A total of 118 patients [hemodialysis (HD, n = 81), and transplant recipients (TX, n = 37)] undergoing PTX between 2015 and 2021 were analyzed.

Results: There was a significant reduction in calcium and PTH levels in both groups, in addition to an increase in vitamin D. In the HD group, PTX did not alter N/L and P/L ratios. In the TX group, there was a reduction in N/L and P/L ratios followed by a significant increase in total lymphocyte count.

Conclusion: N/L and P/L ratios are not reliable biomarkers of inflammation in SHPT patients undergoing PTX. Uremia, which induces a state of chronic inflammation in dialysis patients, and the use of immunosuppression in kidney transplant recipients are some of the confounding factors that prevent the use of this tool in clinical practice.

References

Mendoza J, Isakova T, Ricardo A, Xie H, Navaneethan S, Anderson A . Fibroblast growth factor 23 and Inflammation in CKD. Clin J Am Soc Nephrol. 2012; 7(7):1155-62. PMC: 3386678. DOI: 10.2215/CJN.13281211. View

Griveas I, Visvardis G, Papadopoulou D, Mitsopoulos E, Kyriklidou P, Manou E . Cellular immunity and levels of parathyroid hormone in uremic patients receiving hemodialysis. Ren Fail. 2005; 27(3):275-8. View

Azevedo M, Bonan N, Dias G, Brehm F, Steiner T, Souza W . p-Cresyl sulfate affects the oxidative burst, phagocytosis process, and antigen presentation of monocyte-derived macrophages. Toxicol Lett. 2016; 263:1-5. DOI: 10.1016/j.toxlet.2016.10.006. View

Bhuriya R, Li S, Chen S, McCullough P, Bakris G . Plasma parathyroid hormone level and prevalent cardiovascular disease in CKD stages 3 and 4: an analysis from the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis. 2009; 53(4 Suppl 4):S3-10. DOI: 10.1053/j.ajkd.2008.11.029. View

Azab B, Chainani V, Shah N, McGinn J . Neutrophil-lymphocyte ratio as a predictor of major adverse cardiac events among diabetic population: a 4-year follow-up study. Angiology. 2012; 64(6):456-65. DOI: 10.1177/0003319712455216. View

Yang P, Liu C, Liu T, Chen H, Wu C, Cheng S . Parathyroidectomy decreases neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios. J Surg Res. 2018; 224:169-175. DOI: 10.1016/j.jss.2017.12.016. View

Tonyali S, Ceylan C, Yahsi S, Karakan M . Does neutrophil to lymphocyte ratio demonstrate deterioration in renal function?. Ren Fail. 2018; 40(1):209-212. PMC: 6014370. DOI: 10.1080/0886022X.2018.1455590. View

Aiyegbusi O, McGregor E, McManus S, Stevens K . Immunosuppression Therapy in Kidney Transplantation. Urol Clin North Am. 2022; 49(2):345-360. DOI: 10.1016/j.ucl.2021.12.010. View

Lee T, Bae W, Choi J, Bae E, Jang H, Chang S . The neutrophil-to-lymphocyte ratio may indicate when to start hemodialysis. Ren Fail. 2022; 44(1):1401-1408. PMC: 9397444. DOI: 10.1080/0886022X.2022.2110894. View

10.

Simmons E, Langone A, Sezer M, Vella J, Recupero P, Morrow J . Effect of renal transplantation on biomarkers of inflammation and oxidative stress in end-stage renal disease patients. Transplantation. 2005; 79(8):914-9. DOI: 10.1097/01.tp.0000157773.96534.29. View

11.

Sela S, Shurtz-Swirski R, Cohen-Mazor M, Mazor R, Chezar J, Shapiro G . Primed peripheral polymorphonuclear leukocyte: a culprit underlying chronic low-grade inflammation and systemic oxidative stress in chronic kidney disease. J Am Soc Nephrol. 2005; 16(8):2431-8. DOI: 10.1681/ASN.2004110929. View

12.

Ouellet G, Malhotra R, Penne E, Usvya L, Levin N, Kotanko P . Neutrophil-lymphocyte ratio as a novel predictor of survival in chronic hemodialysis patients. Clin Nephrol. 2016; 85(4):191-8. DOI: 10.5414/CN108745. View

13.

Guthrie G, Charles K, Roxburgh C, Horgan P, McMillan D, Clarke S . The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol. 2013; 88(1):218-30. DOI: 10.1016/j.critrevonc.2013.03.010. View

14.

Levey A, Stevens L, Schmid C, Zhang Y, Castro 3rd A, Feldman H . A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150(9):604-12. PMC: 2763564. DOI: 10.7326/0003-4819-150-9-200905050-00006. View

15.

Crepin T, Legendre M, Carron C, Vachey C, Courivaud C, Rebibou J . Uraemia-induced immune senescence and clinical outcomes in chronic kidney disease patients. Nephrol Dial Transplant. 2018; 35(4):624-632. DOI: 10.1093/ndt/gfy276. View