Vol.:(0123456789) 1 3 International Urology and Nephrology https://doi.org/10.1007/s11255-019-02166-6 NEPHROLOGY - ORIGINAL PAPER The relationship of blood neutrophil‑to‑lymphocyte ratio with nutrition markers and health outcomes in hemodialysis patients Janet Diaz‑Martinez 1  · Adriana Campa 1  · Ivan Delgado‑Enciso 2  · Debra Hain 3  · Florence George 4  · Fatma Hufman 1  · Marianna Baum 1 Received: 29 December 2018 / Accepted: 30 April 2019 © Springer Nature B.V. 2019 Abstract Objective Adverse outcomes in hemodialysis patients have been attributed, in part, to the pro-infammatory state prevalent in this population. This study examines the relationship between blood neutrophil-to-lymphocyte ratio (NLR) with nutrition markers and health outcomes in hemodialysis (HD) patients. Design This is a 12-month prospective cohort study that recruited 77 participants from May to Jun 2017. Settings and subjects Patients receiving maintenance hemodialysis. Main outcomes Hospitalization, transplants and mortality. Results Of the 77 participants, 63.8% were hospitalized, 10 (13%) died of cardiovascular diseases and 6 (7.8%) had a kidney transplant. Spearman correlations using baseline values showed an inverse signifcant correlation between the total number of hospitalizations and BMI kg/m 2 (BMI rho = − 0.37, P <0.001); a signifcant inverse correlation between NLR and albu- min (rho = − 0.22, P = 0.028); and a signifcant direct correlation between baseline NLR and BMI kg/m 2 (rho = 0.22, P = 0.028). Participants were grouped by their NLR value into quartiles for outcomes analysis: quartile 1 (NLR ≤ 1.75), quartile 2 (NLR 1.76–2.6), quartile 3 (NLR 2.7–3.9) and quartile 4 (NLR ≥ 4). The percentage of patients with the lowest level of infammation (NLR ≤ 1.75) was greater for not hospitalized patients than for hospitalized (39.3% vs 16.3%, P = 0.025) and not hospitalized participants had higher BMI kg/m 2 (mean ± SD) at baseline compared to those hospitalized (29.11 ± 5.4 vs 26.22 ± 5.34, P = 0.026). In a multivariate cox regression analysis, participants in the lowest quartile (NLR ≤ 1.75) were compared to the rest on hospitalization, mortality and transplant. Years in dialysis, BMI kg/m 2 and NLR ≤ 1.75 were sig- nifcant predictors of hospitalization after adjustment (P = 0.021, P = 0.005, P = 0.039; respectively) and we observed an association of low NLR with a hazard ratio (HR 0.44, 95% CI 0.20–0.96, P = 0.039), BMI (HR 0.90, 95% CI 0.85–0.97, P = 0.005) and years in dialysis (HR 0.90, 95% CI 0.83–0.98, P = 0.021) for hospitalization in overall participants. In a further analysis comparing the efect of low NLR in the subgroup of diabetic vs non-diabetics, it was observed that BMI kg/ m 2 was a signifcant predictor for hospitalization in the non-diabetic subgroup (P = 0.040) but not signifcant in the case of diabetics (P = 0.128) after adjustments. Years in dialysis and NLR ≤ 1.75 were signifcant predictors of hospitalizations in the subgroup of diabetic before and after adjustment (P = 0.049, P = 0.044; respectively). Having a low NLR decreased 73% the risk for hospitalization (HR 0.27 95% CI 0.07–0.96, P = 0.044) in this subgroup. Survival and hospitalization curves were analyzed by comparing all participants and the diabetic subgroup, in the lowest infammation quartile vs the rest (NLR ≤ 1.75 vs NLR > 1.75). Participants with NLR ≤ 1.75 had 100% survival rate (log-rank test, P = 0.059) and lower hospitalization rate (log-rank test, P = 0.025); participants with diabetes had lower hospitalization rate (log-rank test, P = 0.039). Conclusion NLR at baseline was associated with nutritional markers (albumin, BMI). Low NLR at baseline was a predictor of lower risk for hospitalizations in HD patients with diabetes. Keywords Hemodialysis · Infammation · NLR · Mortality · Hospitalization * Janet Diaz-Martinez jmart556@fu.edu Extended author information available on the last page of the article