The Benefit of Neutrophil to Lymphocyte Ratio vs Platelet to Lymphocyte Ratio as New Indicators of Erythropoietin Resistance in Patients Receiving Hemodialysis

Abstract

Background: Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) have emerged as promising markers in  assessing erythropoietin (EPO) resistance among hemodialysis (HD) patients 

Objective: The purpose of this study was to explore the  potential of the PLR and NLR as indicators of how HD patients respond to erythropoiesis-stimulating agents (ESAs), and to see if PLR and  NLR could help predict which patients might have trouble responding to ESA treatment. 

Patients and Methods: This was a prospective  study involving 100 HD male and female patients over the age of 18 years. The patients were divided into two groups: Group I (n=47)  included patients resistant to ESAs, and Group II (n=53) included patients responsive to ESAs. 

Results: Both PLR and NLR were inversely ncorrelated with hemoglobin levels after three months of ESAs treatmentn and positively correlated with each other. PLR and NLR had  nonsignificant correlations with various clinical and biochemical parameters. According to the PLR and NLR to differentiate EPO  resistance in HD patients from non-EPO resistance in HD patients respectively, at a cut-off value of ≥ 44.98 and0 .835, the sensitivity was  91.5% and 89.4%, the specificity was 77.4% and 62.3%. Erythropoietin resistance index (EHRI), PLR and NLR were significantly correlated  with the prediction of EPO resistance in HD patients. EHRI, PLR and NLR were significantly high between both groups. 

Conclusions: PLR  and NLR could help in assessing both inflammation and EPO resistance in HD patients. Combining these two measures might make it  easier to identify patients who need higher ESA doses.