Results
We reviewed 356 clinical records from patients with CKD who entered
SSCKD between 2016 and 2018. We excluded 12 patients because they did
not have complete laboratory tests and one who did not present a death
date. Finally, we included 343 patients in the analysis. The mean age
was 78.3 (± 11.9) years, and the median follow-up time was 2.45 years
(2.08-3.08). In the population studied, the predominant gender was male,
with 62.9% (n=216). Regarding comorbidities, 64.7% were found to have
hypertension, while 30% have diabetes mellitus. On the other hand, the
average of eGFR was 47.4 (± 10.5) ml / min / 1.73 m2and the ERC stage included 22 (6.4%) patients in stages 1-2, 311 (90,
7%) patients in stages 3a-3b and 10 (2.9%) patients in stages 4-5.
Demographic and laboratory characteristics are shown in Table 1.
Regarding the exposure’s variables, 14.6% (n=50) had high NLR and 8.2%
(n=28) high PLR. In total, 17.5% (n=60) died at the end of follow-up.
Participants with elevated NLR had higher serum levels of alkaline
phosphatase (114 vs 100 U/L; p=0.03) and platelets (260 vs 234 K/uL;
p<0.01) than participants with normal NLR (Table 1).
Participants with elevated PLR had a lower average age (72.6 vs 78.8
years; p<0.01), glutamic oxaloacetic transaminase (19 vs 23
U/L; p=0.02) and hemoglobin (11.2 vs 12.2 g/dL; p<0.01)
compared to participants with normal PLR. In contrast, participants with
elevated PLR had higher serum levels of neutrophils (4.5 vs 3.9 K/uL; p
= 0.03) (Table 2).
The mortality of patients with high NLR was 28% compared to 15.7% of
the group with normal NLR (p = 0.03). Likewise, mortality was 35.7% in
those with high PLR and 15.6% in those with normal PLR (p=0.01). The
mortality rate in the group with high NLR was 12.5 deaths per 100
person-years of follow-up, while in the group with high PLR, it was 16
deaths per 100 person-years of follow-up. Kaplan-Meier curves showed a
statistically significantly worse survival function for participants
with high NLR and PLR at the end of follow-up (Figure 1 and 2).
Mean age was higher in the group of the dead (81.9 vs 77.5 years; p
<0.01) and there was more mortality in males (21.3 vs 11; p =
0.01). The most advanced stages of chronic kidney disease had higher
mortality, 9.1%, 16.4% and 70%, respectively. In the laboratory
profile, creatinine levels were higher in the dead group (1.4 vs 1.6
mg/dL; p<0.01). On the other hand, both hemoglobin (11.7 vs.
12.3 g/dL; p = 0.03) and albumin (4.0 vs. 4.2 mg/dL; p<0.01)
had lower values in the dead group (Table 3).
In the crude analysis, the high NLR was significantly associated with
all-cause mortality (HR = 2.01; 95% CI: 1.11-3.66). Likewise, the high
PLR was significantly associated with all-cause mortality (HR = 2.58;
95% CI: 1.31-5.20) (Table 4).
In the multivariate model, after adjusting for age, sex, serum
creatinine, chronic kidney disease stage, albumin and hemoglobin, the
high NLR and PLR remained as an independent risk factor for all-cause
mortality, (HR = 2.10; 95% CI: 1.11-3.95) and (HR = 2.71; 95% CI:
1.28-5.72); respectively (Table 4).