Platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios as markers of erythropoietin resistance in chronic haemodialysis patients: a multicentre cross-sectional study

Abstract

Introduction: The platelet-to-lymphocyte (PLR) and neutrophil-to-lymphocyte (NLR) ratios are emerging markers of inflammation. Erythropoietin resistance is associated with increased morbidity and mortality in patients with chronic kidney disease and is influenced by inflammation, among other factors. Therefore, it would be reasonable to expect a relationship between these markers and erythropoietin resistance.

Methods: Multicentre cross-sectional study. The records of the haemodialysis sessions of 534 patients belonging to four of our dialysis centres were studied. 137 patients were excluded, so the final number of patients studied was 397. NLR, PLR and the erythropoietin resistance index (ERI) were calculated.

Results: The ERI was divided into quartiles and compared with the mean NLR and PLR of the four groups, with these differences being statistically significant (p=0.00058). In the regression analysis, the NLR value was able to predict ERI significantly (p<0.0001) (R²=0.029). The PLR value also predicted ERI significantly (p<0.0001) (R²=0.103). The ability of PLR to predict erythropoietin resistance was measured with the area under the ROC curve (AUC=0.681) (95% CI, 0.541-0.821). A PLR cut-off point of 125.5 would result in a sensitivity of 80.95% and 42.82% specificity.

Conclusions: Both PLR and NLR could be considered acceptable markers of erythropoietin resistance. The PLR was a better predictor for the ERI than the NLR.

Keywords: Chronic haemodialysis; Erythropoietin resistance; Hemodiálisis crónica; Neutrophil-lymphocyte ratio; Platelet-lymphocyte ratio; Resistencia a la eritropoyetina; Índice neutrófilo-linfocito; Índice plaqueta-linfocito.