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Hemodiyaliz hastalarında bazal trombosit lenfosit oranı ile mortalite arasındaki ilişki

Year 2019, Volume: 44 Issue: Supplement 1, 400 - 411, 29.12.2019
https://doi.org/10.17826/cumj.566275

Abstract

Amaç: Bu çalışmada, hemodiyaliz hastalarında trombosit-lenfosit oranı (PLR) ve nötrofil-lenfosit oranı (NLR) gibi temel parametrelerin mortalite ile ilişkisinin değerlendirilmesi amaçlanmıştır..

Gereç ve Yöntem: Bu çalışmada, 1999-2017 yılları arasında, 3 aydan uzun süre hemodiyalize giren 129 hasta retrospektif olarak değerlendirildi. Hastalar dışlama kriterlerinden sonra, halen diyalize giren (n=66) ve ölen (n=33) olarak 2 gruba ayrıldı. Hastaların hemodiyaliz başlangıç (hemodiyalizden sonraki üçüncü ay) klinik ve laboratuvar kayıtları değerlendirilerek mortalite ile ilişkisi araştırıldı.

Bulgular: Hastaların yaş ortalaması 57 ± 18,9 yıl (13-93), % 46,5'i (46) kadın ve ortalama hemodiyaliz süresi 35.02 ± 30.44 ay idi.  Kaplan Meier sağkalım analizine göre PLR, sağ kalan hemodiyaliz hastalarına kıyasla ölen hemodiyaliz hastalarında anlamlı olarak daha yüksekti, ancak NLR sağ kalan ya da ölen hemodiyaliz hastalarında farklı değildi. Çok değişkenli Cox regresyon analiz modelinde, mortalite ile ilişkili faktörler PLR ve serum sodyum idi.

Sonuç: Bazal PLR ve serum sodyumun mortalite için hassas biyobelirteçler olduğunu söyleyebiliriz. Hemodiyalizin 3.  ayındaki bazal PLR,  kolay erişilebilir, ucuz ve basit bir belirteç olup takip süresince mortalite göstergesi olabilir.


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References

  • Referans 1. Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998;32(5 Suppl 3):S112-9. Referans 2. Dummer CD, Thome FS, Veronese FV. Doença renal crônica, inflamação e aterosclerose: novos conceitos de um velho problema [Chronic renal disease, inflammation and atherosclerosis: new concepts about an old problem]. Rev Assoc Med Bras (1992). 2007;53(5):446-50. Referans 3. Dai L, Golembiewska E, Lindholm B, Stenvinkel P. End-Stage Renal Disease, Inflammation and Cardiovascular Outcomes. Contrib Nephrol. 2017;191:32-43. Referans 4. Akchurin OM, Kaskel F. Update on inflammation in chronic kidney disease. Blood Purif. 2015;39(1-3):84-92. Referans 5. Kalantar-Zadeh K, Stenvinkel P, Pillon L, Kopple JD. Inflammation and nutrition in renal insufficiency. Adv Ren Replace Ther. 2003;10(3):155-69. Referans 6. Stenvinkel P, Alvestrand A. Inflammation in end-stage renal disease: sources, consequences, and therapy. Semin Dial. 2002;15(5):329-37.Referans 7. Yeun JY, Levine RA, Mantadilok V, Kaysen GA. C-Reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis. 2000;35(3):469-76. Referans 8. Qureshi AR, Alvestrand A, Divino-Filho JC, et al. Inflammation, malnutrition, and cardiac disease as predictors of mortality in hemodialysis patients. J Am Soc Nephrol. 2002;13 Suppl 1:S28-36. Referans 9. Zhang W, He J, Zhang F, et al. Prognostic role of C-reactive protein and interleukin-6 in dialysis patients: a systematic review and meta-analysis. J Nephrol. 2013;26(2):243-53. Referans 10. Hsu HC, Tsai WH, Jiang ML, et al. Circulating levels of thrombopoietic and inflammatory cytokines in patients with clonal and reactive thrombocytosis. J Lab Clin Med. 1999;134(4):392-7.Referans 11. Sayinalp N, Haznedaroğlu IC, Ozdemir O, et al. Interleukin-1 beta and interleukin-6 in clonal versus reactive thrombocytosis. Eur J Haematol. 1995;55(5):339-40. Referans 12. Tefferi A, Ho TC, Ahmann GJ, Katzmann JA, Greipp PR. Plasma interleukin-6 and C-reactive protein levels in reactive versus clonal thrombocytosis. Am J Med. 1994;97(4):374-8.Referans 13. Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102(1):5-14. Referans 14. Ouellet G, Malhotra R, Penne EL, et al. Neutrophil-lymphocyte ratio as a novel predictor of survival in chronic hemodialysis patients. Clin Nephrol. 2016;85(4):191-8. Referans 15. Templeton AJ, Ace O, McNamara MG, et al. Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev. 2014;23(7):1204-12.Referans 16. Ozcan Cetin EH, Cetin MS, Aras D, et al. Platelet to Lymphocyte Ratio as a Prognostic Marker of In-Hospital and Long-Term Major Adverse Cardiovascular Events in ST-Segment Elevation Myocardial Infarction. Angiology. 2016;67(4):336-45. Referans 17. Ozcan Cetin EH, Cetin MS, Canpolat U, et al. Platelet-to-lymphocyte ratio as a novel marker of in-hospital and long-term adverse outcomes among patients with acute pulmonary embolism: A single center large-scale study. Thromb Res. 2017;150:33-40. Referans 18. Jofré R, Rodriguez-Benitez P, López-Gómez JM, Pérez-Garcia R. Inflammatory syndrome in patients on hemodialysis. J Am Soc Nephrol. 2006;17(12 Suppl 3):S274-80. Referans 19. Sueta D, Hokimoto S, Sakamoto K, et al. Validation of the high mortality rate of Malnutrition-Inflammation-Atherosclerosis syndrome: -Community-based observational study. Int J Cardiol. 2017;230:97-102. Referans 20. Zhu JG, Chen JB, Cheng BC, et al. Association between Extreme Values of Markers of Chronic Kidney Disease: Mineral and Bone Disorder and 5-Year Mortality among Prevalent Hemodialysis Patients. Blood purification. 2018;45(1-3):1-7. Referans 21. Cheung AK, Sarnak MJ, Yan G, et al. Cardiac diseases in maintenance hemodialysis patients: results of the HEMO Study. Kidney int. 2004;65(6):2380-9.Referans 22. Baber U, Gutierrez OM, Levitan EB, et al. Risk for recurrent coronary heart disease and all-cause mortality among individuals with chronic kidney disease compared with diabetes mellitus, metabolic syndrome, and cigarette smokers. Am Heart J. 2013;166(2):373-80 Referans 23. Shlipak MG, Fried LF, Cushman M, Manolio TA, Peterson D, Stehman-Breen C, et al. Cardiovascular mortality risk in chronic kidney disease: comparison of traditional and novel risk factors. JAMA. 2005;293(14):1737-45. Referans 24. Streetz KL, Wustefeld T, Klein C, Manns MP, Trautwein C. Mediators of inflammation and acute phase response in the liver. Cell Mol Biol (Noisy-le-grand). 2001;47(4):661-73.Referans 25. Silverstein DM. Inflammation in chronic kidney disease: role in the progression of renal and cardiovascular disease. Pediatr Nephrol. 2009;24(8):1445-52. Referans 26. Afsar B, Turkmen K, Covic A, Kanbay M. An update on coronary artery disease and chronic kidney disease. Int J Nephrol. 2014;2014:767424. Referans 27. Cheung AK, Sarnak MJ, Yan G, et al. Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients. Kidney Int. 2000;58(1):353-62. Referans 28. Meuwese CL, Carrero JJ, Stenvinkel P. Recent insights in inflammation-associated wasting in patients with chronic kidney disease. Contrib Nephrol. 2011;171:120-6.Referans 29. Agarwal R. Hypervolemia is associated with increased mortality among hemodialysis patients. Hypertension. 2010;56(3):512-7. Referans 30. Rodrigues Telini LS, de Carvalho Beduschi G, Caramori JC, et al. Effect of dietary sodium restriction on body water, blood pressure, and inflammation in hemodialysis patients: a prospective randomized controlled study. Int Urol Nephrol. 2014;46(1):91-7.Referans 31. Pecoits-Filho R, Lindholm B, Stenvinkel P. The malnutrition, inflammation, and atherosclerosis (MIA) syndrome -- the heart of the matter. Nephrol Dial Transplant. 2002;17 Suppl 11:28-31. Referans 32. Niebauer J, Volk HD, Kemp M, et al. Endotoxin and immune activation in chronic heart failure: a prospective cohort study. Lancet. 1999;353(9167):1838-42.Referans 33. Owen WF Jr, Lew NL, Liu Y, Lowrie EG, Lazarus JM. The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. N Engl J Med. 1993;329(14):1001-6. Referans 34. Leavey SF, Strawderman RL, Jones CA, Port FK, Held PJ. Simple nutritional indicators as independent predictors of mortality in hemodialysis patients. Am J Kidney Dis. 1998;31(6):997-1006. Referans 35. Turkmen K, Guney I, Yerlikaya FH, Tonbul HZ. The relationship between neutrophil-to-lymphocyte ratio and inflammation in end-stage renal disease patients. Ren Fail. 2012;34(2):155-9. Referans 36. Turkmen K, Erdur FM, Ozcicek F, et al. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int. 2013;17(3):391-6.Referans 37. Ahbap E, Sakaci T, Kara E, et al. Neutrophil-to-lymphocyte ratio and platelet-tolymphocyte ratio in evaluation of inflammation in end-stage renal disease. Clin Nephrol. 2016;85(4):199-208. Referans 38. Yaprak M, Turan MN, Dayanan R, et al. Platelet-to-lymphocyte ratio predicts mortality better than neutrophil-to-lymphocyte ratio in hemodialysis patients. Int Urol Nephrol. 2016;48(8):1343-8.Referans 39. Eleftheriadis T, Antoniadi G, Liakopoulos V, Kartsios C, Stefanidis I. Disturbances of acquired immunity in hemodialysis patients. Semin Dial. 2007;20(5):440-51.Referans 40. Yao Q, Lindholm B, Stenvinkel P. Inflammation as a cause of malnutrition, atherosclerotic cardiovascular disease, and poor outcome in hemodialysis patients. Hemodial Int. 2004;8(2):118-29.

Relationship between mortality and baseline platelet to lymphocyte ratio in hemodialysis patients

Year 2019, Volume: 44 Issue: Supplement 1, 400 - 411, 29.12.2019
https://doi.org/10.17826/cumj.566275

Abstract

Purpose: The aim of this study was to evaluate baseline parameters including platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) as predictive value for mortality in hemodialysis patients.

Materials and Methods: In this study 129 patients undergoing hemodialysis more than 3 months, were evaluated for survival between 1999 and 2017. In the 3. Month of beginning of hemodialysis clinical and laboratory parameters of the patients were evaluated retrospectively. The patients were separated into 2 groups as dead and living. After 30 excluded patients due to study criteria, 33 paients of the remaining 99 patients died and 66 were still undergoing hemodialysis.

Results: The mean age of patients was 57 ± 18.9 years (13-93), 46.5% (46) were female and mean hemodialysis vintage was 35.02 ± 30.44 months. According to Kaplan Meier, survival analysis PLR was significantly higher in hemodialysis patients who died compared to surviving hemodialysis patients but NLR was not different in hemodialysis patients who surviving or died. Multivariate Cox regression analysis model, correlated factors associated with mortality were PLR and serum sodium.

Conclusion: Baseline PLR and serum sodium were found to be sensitive biomarkers for mortality. Baseline 3. hemodialysis month PLR of which is easily accessible, inexpensive and simple, can be a predictor of mortality at follow up period in hemodialysis patients.


References

  • Referans 1. Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998;32(5 Suppl 3):S112-9. Referans 2. Dummer CD, Thome FS, Veronese FV. Doença renal crônica, inflamação e aterosclerose: novos conceitos de um velho problema [Chronic renal disease, inflammation and atherosclerosis: new concepts about an old problem]. Rev Assoc Med Bras (1992). 2007;53(5):446-50. Referans 3. Dai L, Golembiewska E, Lindholm B, Stenvinkel P. End-Stage Renal Disease, Inflammation and Cardiovascular Outcomes. Contrib Nephrol. 2017;191:32-43. Referans 4. Akchurin OM, Kaskel F. Update on inflammation in chronic kidney disease. Blood Purif. 2015;39(1-3):84-92. Referans 5. Kalantar-Zadeh K, Stenvinkel P, Pillon L, Kopple JD. Inflammation and nutrition in renal insufficiency. Adv Ren Replace Ther. 2003;10(3):155-69. Referans 6. Stenvinkel P, Alvestrand A. Inflammation in end-stage renal disease: sources, consequences, and therapy. Semin Dial. 2002;15(5):329-37.Referans 7. Yeun JY, Levine RA, Mantadilok V, Kaysen GA. C-Reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis. 2000;35(3):469-76. Referans 8. Qureshi AR, Alvestrand A, Divino-Filho JC, et al. Inflammation, malnutrition, and cardiac disease as predictors of mortality in hemodialysis patients. J Am Soc Nephrol. 2002;13 Suppl 1:S28-36. Referans 9. Zhang W, He J, Zhang F, et al. Prognostic role of C-reactive protein and interleukin-6 in dialysis patients: a systematic review and meta-analysis. J Nephrol. 2013;26(2):243-53. Referans 10. Hsu HC, Tsai WH, Jiang ML, et al. Circulating levels of thrombopoietic and inflammatory cytokines in patients with clonal and reactive thrombocytosis. J Lab Clin Med. 1999;134(4):392-7.Referans 11. Sayinalp N, Haznedaroğlu IC, Ozdemir O, et al. Interleukin-1 beta and interleukin-6 in clonal versus reactive thrombocytosis. Eur J Haematol. 1995;55(5):339-40. Referans 12. Tefferi A, Ho TC, Ahmann GJ, Katzmann JA, Greipp PR. Plasma interleukin-6 and C-reactive protein levels in reactive versus clonal thrombocytosis. Am J Med. 1994;97(4):374-8.Referans 13. Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102(1):5-14. Referans 14. Ouellet G, Malhotra R, Penne EL, et al. Neutrophil-lymphocyte ratio as a novel predictor of survival in chronic hemodialysis patients. Clin Nephrol. 2016;85(4):191-8. Referans 15. Templeton AJ, Ace O, McNamara MG, et al. Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev. 2014;23(7):1204-12.Referans 16. Ozcan Cetin EH, Cetin MS, Aras D, et al. Platelet to Lymphocyte Ratio as a Prognostic Marker of In-Hospital and Long-Term Major Adverse Cardiovascular Events in ST-Segment Elevation Myocardial Infarction. Angiology. 2016;67(4):336-45. Referans 17. Ozcan Cetin EH, Cetin MS, Canpolat U, et al. Platelet-to-lymphocyte ratio as a novel marker of in-hospital and long-term adverse outcomes among patients with acute pulmonary embolism: A single center large-scale study. Thromb Res. 2017;150:33-40. Referans 18. Jofré R, Rodriguez-Benitez P, López-Gómez JM, Pérez-Garcia R. Inflammatory syndrome in patients on hemodialysis. J Am Soc Nephrol. 2006;17(12 Suppl 3):S274-80. Referans 19. Sueta D, Hokimoto S, Sakamoto K, et al. Validation of the high mortality rate of Malnutrition-Inflammation-Atherosclerosis syndrome: -Community-based observational study. Int J Cardiol. 2017;230:97-102. Referans 20. Zhu JG, Chen JB, Cheng BC, et al. Association between Extreme Values of Markers of Chronic Kidney Disease: Mineral and Bone Disorder and 5-Year Mortality among Prevalent Hemodialysis Patients. Blood purification. 2018;45(1-3):1-7. Referans 21. Cheung AK, Sarnak MJ, Yan G, et al. Cardiac diseases in maintenance hemodialysis patients: results of the HEMO Study. Kidney int. 2004;65(6):2380-9.Referans 22. Baber U, Gutierrez OM, Levitan EB, et al. Risk for recurrent coronary heart disease and all-cause mortality among individuals with chronic kidney disease compared with diabetes mellitus, metabolic syndrome, and cigarette smokers. Am Heart J. 2013;166(2):373-80 Referans 23. Shlipak MG, Fried LF, Cushman M, Manolio TA, Peterson D, Stehman-Breen C, et al. Cardiovascular mortality risk in chronic kidney disease: comparison of traditional and novel risk factors. JAMA. 2005;293(14):1737-45. Referans 24. Streetz KL, Wustefeld T, Klein C, Manns MP, Trautwein C. Mediators of inflammation and acute phase response in the liver. Cell Mol Biol (Noisy-le-grand). 2001;47(4):661-73.Referans 25. Silverstein DM. Inflammation in chronic kidney disease: role in the progression of renal and cardiovascular disease. Pediatr Nephrol. 2009;24(8):1445-52. Referans 26. Afsar B, Turkmen K, Covic A, Kanbay M. An update on coronary artery disease and chronic kidney disease. Int J Nephrol. 2014;2014:767424. Referans 27. Cheung AK, Sarnak MJ, Yan G, et al. Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients. Kidney Int. 2000;58(1):353-62. Referans 28. Meuwese CL, Carrero JJ, Stenvinkel P. Recent insights in inflammation-associated wasting in patients with chronic kidney disease. Contrib Nephrol. 2011;171:120-6.Referans 29. Agarwal R. Hypervolemia is associated with increased mortality among hemodialysis patients. Hypertension. 2010;56(3):512-7. Referans 30. Rodrigues Telini LS, de Carvalho Beduschi G, Caramori JC, et al. Effect of dietary sodium restriction on body water, blood pressure, and inflammation in hemodialysis patients: a prospective randomized controlled study. Int Urol Nephrol. 2014;46(1):91-7.Referans 31. Pecoits-Filho R, Lindholm B, Stenvinkel P. The malnutrition, inflammation, and atherosclerosis (MIA) syndrome -- the heart of the matter. Nephrol Dial Transplant. 2002;17 Suppl 11:28-31. Referans 32. Niebauer J, Volk HD, Kemp M, et al. Endotoxin and immune activation in chronic heart failure: a prospective cohort study. Lancet. 1999;353(9167):1838-42.Referans 33. Owen WF Jr, Lew NL, Liu Y, Lowrie EG, Lazarus JM. The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. N Engl J Med. 1993;329(14):1001-6. Referans 34. Leavey SF, Strawderman RL, Jones CA, Port FK, Held PJ. Simple nutritional indicators as independent predictors of mortality in hemodialysis patients. Am J Kidney Dis. 1998;31(6):997-1006. Referans 35. Turkmen K, Guney I, Yerlikaya FH, Tonbul HZ. The relationship between neutrophil-to-lymphocyte ratio and inflammation in end-stage renal disease patients. Ren Fail. 2012;34(2):155-9. Referans 36. Turkmen K, Erdur FM, Ozcicek F, et al. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int. 2013;17(3):391-6.Referans 37. Ahbap E, Sakaci T, Kara E, et al. Neutrophil-to-lymphocyte ratio and platelet-tolymphocyte ratio in evaluation of inflammation in end-stage renal disease. Clin Nephrol. 2016;85(4):199-208. Referans 38. Yaprak M, Turan MN, Dayanan R, et al. Platelet-to-lymphocyte ratio predicts mortality better than neutrophil-to-lymphocyte ratio in hemodialysis patients. Int Urol Nephrol. 2016;48(8):1343-8.Referans 39. Eleftheriadis T, Antoniadi G, Liakopoulos V, Kartsios C, Stefanidis I. Disturbances of acquired immunity in hemodialysis patients. Semin Dial. 2007;20(5):440-51.Referans 40. Yao Q, Lindholm B, Stenvinkel P. Inflammation as a cause of malnutrition, atherosclerotic cardiovascular disease, and poor outcome in hemodialysis patients. Hemodial Int. 2004;8(2):118-29.
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Details

Primary Language English
Subjects Urology
Journal Section Research
Authors

Bülent Kaya 0000-0003-4697-4815

Saime Paydaş 0000-0001-6651-8265

Ertan Kara This is me 0000-0003-2486-8683

Publication Date December 29, 2019
Acceptance Date August 6, 2019
Published in Issue Year 2019 Volume: 44 Issue: Supplement 1

Cite

MLA Kaya, Bülent et al. “Relationship Between Mortality and Baseline Platelet to Lymphocyte Ratio in Hemodialysis Patients”. Cukurova Medical Journal, vol. 44, 2019, pp. 400-11, doi:10.17826/cumj.566275.