Association between Neutrophil-Lymphocyte Ratio (NLR) and Clinical Outcomes among Filipino Patients with End-Stage Renal Disease (ESRD) Secondary to Diabetic Nephropathy on Maintenance Hemodialysis

The incidence of end-stage renal disease (ESRD) is increasing in the Philippines. The presence of diabetes mellitus further worsens ESRD prognosis. The neutrophil-to-lymphocyte ratio (NLR) is a reliable prognostic marker for mortality, but its usefulness as a prognostic biomarker in diabetes patients with chronic kidney disease is yet to be clarified. This study aimed to determine the association between NLR and morbidity among Filipino patients with end-stage renal disease (ESRD) secondary to diabetic nephropathy on maintenance hemodialysis. This was an observational descriptive, prospective cohort study that evaluated outpatient Filipino citizens aged > 18 years diagnosed with ESRD secondary to type 2 diabetes mellitus (T2DM). All patients had good compliance with their hemodialysis regimen (i.e., at least twice weekly dialysis within the past 3 months). The patients were divided into two groups according to the baseline NLR value at a cut-off of 3.5 as the high NLR group (≥3.5) and the low NLR group (<3.5). The cutoff was based on data that a high NLR of ≥3.5 was correlated with increased inflammatory states leading to higher morbidity. Patients were followed up after 6 months, and data on the primary outcome measure of disease occurrence were collected. Of the 63 patients evaluated, the majority (n = 39, 61.9%) had a baseline NLR value of <3.5. The high NLR group included 24 (38.1%) patients; among them, 9 developed diseases. In the low NLR group (n = 39), only 2 patients developed disease. NLR was significantly correlated with clinical disease outcomes (p ≤ 0.05). A baseline NLR of ≥3.5 was associated with disease occurrence. In conclusion, patients with a high baseline NLR have an increased inflammatory state and a higher risk of developing disease conditions than patients with an NLR < 3.5. Thus, the baseline NLR value can be used to predict prognosis in T2DM patients with ESRD.