Systemic inflammation indices in chronic kidney disease: clinical significance and prognostic aspects

THE

Aim

to investigate systemic inflammation indices and their association with risk factors for cardiovascular complications in patients with chronic kidney disease (CKD). PATIENTS AND

Methods

The study included 744 patients (454 men and 290 women) with CKD at predialysis stages; the mean age was 38.3 ± 13.0 years. Patients were divided into two groups: Group 1 – CKD with subnephrotic proteinuria (<3.5 g/day, n = 478); Group 2 – CKD with nephrotic proteinuria (>3.5 g/day, n = 266). All patients underwent peripheral blood and biochemical analyses with the calculation of systemic inflammation indices.

Results

In the group of patients with CKD and nephrotic proteinuria, leukocyte count, erythrocyte sedimentation rate, and plasma fibrinogen concentration were significantly higher than in patients with CKD and subnephrotic proteinuria. The platelet-to-lymphocyte ratio (PLR) was higher in patients with CKD and nephrotic proteinuria (8.92 ± 3.39 vs 8.12 ± 2.20, p = 0.001), whereas the lymphocyte-to-C-reactive protein ratio (L/C-RP) was higher in patients with CKD and subnephrotic proteinuria (0.833 [0.167; 2.583] vs 0.323 [0.156; 1.917], p = 0.031). Correlation analysis showed that leukocyte count was positively associated with heart rate (r = 0.264; p < 0.05), total cholesterol (r = 0.119; p < 0.05), and daily proteinuria (r = 0.097; p < 0.05); lymphocyte count correlated with diastolic blood pressure (r = 0.214; p < 0.05); PLR correlated with heart rate (r = 0.376; p < 0.05) and LDL cholesterol (r = 0.374; p < 0.05); LDL cholesterol correlated negatively with L/M (r = –0.253; p < 0.05) and M/L (r = 0.287; p < 0.05). Estimated glomerular filtration rate (eGFR) correlated with L/C-RP (r = 0.300; p < 0.05), systemic inflammation response index (SIRI, r = –0.079; p < 0.05), and neutrophil-to-lymphocyte ratio (NLR, r = –0.077; p < 0.05). A negatively correlation was found between L/C-RP and plasma fibrinogen levels (r = –0.267; p < 0.05).

Conclusion

In patients with CKD and subnephrotic proteinuria, the lymphocyte-to-C-reactive protein ratio was higher, whereas the platelet-to-lymphocyte ratio was higher in those with CKD and nephrotic proteinuria. Systemic inflammation indices (L/CRP, SIRI, NLR) showed a strong correlation with glomerular filtration rate and were independently associated with the risk of renal function decline and cardiovascular complications.