Clinical significance of neutrophil-to-lymphocyte ratio on the risk of abdominal aortic calcification and decreased bone mineral density in patients with end-stage kidney disease

Abstract

Inflammation plays a major role in the pathogenesis of chronic kidney disease (CKD), but the relationship between systemic inflammation and CKD-mineral bone disease is unclear. We aimed to investigate whether the neutrophil-to-lymphocyte ratio (NLR) is related to abdominal aortic calcification (AAC) and bone mineral density (BMD) in dialysis patients. In this cross-sectional analysis using baseline data of a multicenter cohort, a total of 759 patients were divided into three groups according to NLR level, and the associations between NLR and Kauppila AAC score (AACS) and BMD were assessed. The highest tertile NLR group had more males, alcohol consumers, higher diabetes prevalence, and higher comorbidity index than the lowest tertile NLR group. Fasting glucose and C-reactive protein levels were higher, while serum albumin, serum iron, and lipid profiles except triglycerides were lower in the highest tertile group. AACS was significantly higher in the highest tertile group than in the lowest and middle tertile groups (p = 0.017), but the mean areal BMD and T-score of the lumbar spine and femur were not different between groups. NLR level was positively correlated with AACS in all aortic wall segments except L1 and L3 anterior. In multivariable logistic regression analysis, the highest tertile NLR group was independently associated with AAC (odds ratio 2.876, 95% confidence interval 1.250-6.619, p = 0.013) but was not associated with osteoporosis in the lumbar spine and femur after adjusting for confounding factors. The NLR can be used as a potential indicator of AAC in dialysis patients.

Fig 1. Study design and flow chart of study participants.

Fig 2. Distribution of BMD according to NLR in dialysis patients.

(a) Mean L1–4 T-score, (b) Total hip T-score, (c) Femur neck T-score, NLR T1, NLR 1^st tertile; NLR T2, NLR 2^nd tertile; NLR T3, NLR 3^rd tertile.

Fig 3. Distribution of BMD according to NLR stratified by sex in dialysis patients.

(a) Male, mean L1–4 T-score, (b) Male, Total hip T-score, (c) Male, Femur neck T-score, (d) Female, mean L1–4 T-score, (e) Female, Total hip T-score, (f) Female, Femur neck T-score. NLR T1, NLR 1^st tertile; NLR T2, NLR 2^nd tertile; NLR T3, NLR 3^rd tertile.