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. 2025 Jan 10;26(1):39.
doi: 10.1186/s12891-025-08291-x.

Neutrophil-to-lymphocyte ratio as a novel predictor of sarcopenia in maintenance hemodialysis patients: a cross-sectional study exploring associations across body composition categories

Yogesh M  1 , Parth Anilbhai Parmar  2 , Soumya Sharma  3 , Jay Pareshbhai Kakadiya  3 , Dhruv Lakkad  3
Affiliations

Neutrophil-to-lymphocyte ratio as a novel predictor of sarcopenia in maintenance hemodialysis patients: a cross-sectional study exploring associations across body composition categories

Yogesh M et al. BMC Musculoskelet Disord. .

Abstract

Background: Sarcopenia is prevalent among hemodialysis patients and is associated with poor outcomes. The neutrophil-to-lymphocyte ratio (NLR), an easily obtainable marker of inflammation, may predict sarcopenia risk. This study aimed to investigate the association between NLR and sarcopenia risk in maintenance hemodialysis patients, examining this association in the context of obesity.

Methods: This cross-sectional study included 411 maintenance hemodialysis patients. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria-2019 (AWGS 2019). Body composition was assessed using bioelectrical impedance analysis. Logistic regression models examined associations between NLR and sarcopenia risk, adjusting for potential confounders. Analyses were stratified by obesity status.

Results: The prevalence of sarcopenia was 51% (95% CI: 45.1-54.9%), with 37.2% classified as sarcopenic non-obese and 13.6% as sarcopenic obese. In fully adjusted models, each unit increase in NLR was associated with 10% higher odds of sarcopenia overall (OR 1.10, 95% CI: 1.00-1.21, p = 0.048). This association remained significant in sarcopenic obese patients (OR 1.15, 95% CI: 1.00-1.32, p = 0.049). Patients in the highest NLR tertile had 1.95 times higher odds of sarcopenia compared to the lowest tertile (95% CI: 1.12-3.40, p = 0.018), with a significant trend across tertiles (p-trend = 0.015).

Conclusions: NLR is independently associated with sarcopenia risk in hemodialysis patients, including those with obesity. These findings suggest NLR could serve as a simple, cost-effective tool for identifying hemodialysis patients at high risk of sarcopenia, potentially facilitating early intervention strategies.

Keywords: AWGS 2019; Hemodialysis; Neutrophil-to-lymphocyte ratio; Obesity; Prevalence; Sarcopenia.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Good clinical care guidelines were followed, and the guidelines were established as per the Helsinki Declaration 2008. All the participants were given clear instructions about the study before the start of the study. Written informed consent was obtained from the patients in the vernacular language for study participation. No identifying information or images have been included in the original article, which was submitted for publication in an online open-access publication. The entire methodology and protocol were approved by the Institutional Ethical Committee of Shri M P Shah Government Medical College, Jamnagar, Gujarat, India. The study protocol was reviewed and approved by the institutional review board or ethics committee. (approval number: 03/01/2023).Our study is not a clinical trial(so clinical trial registration number is not applicable). Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests.

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