Nephropathy, but not Angiographically Proven Retinopathy, is Associated with Neutrophil to Lymphocyte Ratio in Patients with Type 2 Diabetes

Abstract

Background: Type 2 Diabetes Mellitus is a leading cause of end stage renal disease in the worldwide. Inflammation is regarded as one of the main reasons for the progression of diabetes complications. We aimed to evaluate the association of neutrophil to lymphocyte ratio (NLR) as indicator of systemic inflammation with diabetic retinopathy and nephropathy.

Patients and Methods: This is a cross-sectional study of 114 prevalent type 2 diabetic subjects. All of the patients underwent detailed examination for the presence of diabetic retinopathy and nephropathy. Diabetic retinopathy was approved and classified according to findings based on flouresceint fundal angiography results. Estimated glomerular filtration rate (eGFR) and microalbumin to creatinine ratio were calculated to establish the diabetic nephropathy. NLR was calculated as ratio of absolute neutrophil count to absolute lymphocyte count.

Results: Retinopathy was present in 55 (48.2%) out of 114 patients, whereas nephropathy was present in 62 patients (54.3%). NLR was significantly higher in patients with nephropathy than in patients without nephropathy. NLR was also positively correlated with CRP (p=0.017, r=0.224) and microalbuminuria (p=0.016, r=0.257) whereas negatively correlated with eGFR (p<0.001, r=−0.337) values in the whole cohort. NLR was independent predictors for diabetic nephropathy, whereas it did not appear as an independent associate of diabetic retinopathy.

Conclusion: NLR and diabetic nephropathy have an independent association between them whereas there was no independent association between NLR with retinopathy in type 2 diabetic patients.

Key words

neutrophil to lymphocyte ratio - diabetic nephropathy - diabetic retinopathy - inflammation - type 2 diabetes mellitus

• References

• 1 Shoelson SE, Lee J, Goldfine AB. Inflammation and insulin resistance. J Clin Invest 2006; 116: 1793-1801
• 2 Stringhini S, Batty GD, Bovet P et al. Association of lifecourse socioeconomic status with chronic inflammation and type 2 diabetes risk: the Whitehall II prospective cohort study. PLoS Med 2013; 10: e1001479 PMEDICINE-D-12-03615 [pii]
• 3 Macisaac RJ, Ekinci EI, Jerums G. Markers of and risk factors for the development and progression of diabetic kidney disease. Am J Kidney Dis 2014; 63: S39-S62 S0272-6386(13)01431-5 [pii]
• 4 Niewczas MA, Ficociello LH, Johnson AC et al. Serum concentrations of markers of TNFalpha and Fas-mediated pathways and renal function in nonproteinuric patients with type 1 diabetes. Clin J Am Soc Nephrol 2009; 4: 62-70 CJN.03010608 [pii]
• 5 Roy MS, Janal MN, Crosby J et al. Inflammatory biomarkers and progression of diabetic retinopathy in African Americans with type 1 diabetes. Invest Ophthalmol Vis Sci 2013; 54: 5471-5480
• 6 Kastelan S, Tomic M, Gverovic Antunica A et al. Inflammation and pharmacological treatment in diabetic retinopathy. Mediators Inflamm 2013; 2013: 213130
• 7 Solak Y, Yilmaz MI, Sonmez A et al. Neutrophil to lymphocyte ratio independently predicts cardiovascular events in patients with chronic kidney disease. Clin Exp Nephrol 2013; 17: 532-540
• 8 Biyik M, Ucar R, Solak Y et al. Blood neutrophil-to-lymphocyte ratio independently predicts survival in patients with liver cirrhosis. Eur J Gastroenterol Hepatol 2013; 25: 435-441
• 9 Ghaffari S, Nadiri M, Pourafkari L et al. The predictive Value of Total Neutrophil Count and Neutrophil/Lymphocyte Ratio in Predicting In-hospital Mortality and Complications after STEMI. J Cardiovasc Thorac Res 2014; 6: 35-41
• 10 Ulu SM, Dogan M, Ahsen A et al. Neutrophil-to-lymphocyte ratio as a quick and reliable predictive marker to diagnose the severity of diabetic retinopathy. Diabetes Technol Ther 2013; 15: 942-947
• 11 Ozturk ZA, Kuyumcu ME, Yesil Y et al. Is there a link between neutrophil-lymphocyte ratio and microvascular complications in geriatric diabetic patients?. J Endocrinol Invest 2013; 36: 593-599
• 12 Fong DS, Aiello L, Gardner TW et al. Diabetic retinopathy. Diabetes Care 2003; 26: 226-229
• 13 Treacy MP, Hurst TP, Conway M et al. The Early Treatment in Diabetic Retinopathy Study Chart Compared with the Tumbling-E and Landolt-C. Ophthalmology 2015; [pii]10.1016/j.ophtha.2014.11.024
• 14 Peterson JC, Adler S, Burkart JM et al. Blood pressure control, proteinuria, and the progression of renal disease. The Modification of Diet in Renal Disease Study. Ann Intern Med 1995; 123: 754-762
• 15 KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. Am J Kidney Dis 2007; 49: S12-S154 [pii]10.1053/j.ajkd.2006.12.005
• 16 Oberg BP, McMenamin E, Lucas FL et al. Increased prevalence of oxidant stress and inflammation in patients with moderate to severe chronic kidney disease. Kidney Int 2004; 65: 1009-1016
• 17 Afsar B. The relationship between neutrophil lymphocyte ratio with urinary protein and albumin excretion in newly diagnosed patients with type 2 diabetes. Am J Med Sci 2014; 347: 217-220
• 18 Binnetoglu E, Sengul E, Halhalli G et al. Is Neutrophil Lymphocyte Ratio an Indicator for Proteinuria in Chronic Kidney Disease?. J Clin Lab Anal 2014;
• 19 Tanindi A, Erkan AF, Ekici B et al. Neutrophil to lymphocyte ratio is associated with more extensive, severe and complex coronary artery disease and impaired myocardial perfusion. Turk Kardiyol Dern Ars 2014; 42: 125-130
• 20 Acar G, Fidan S, Uslu ZA et al. Relationship of Neutrophil-Lymphocyte Ratio With the Presence, Severity, and Extent of Coronary Atherosclerosis Detected by Coronary Computed Tomography Angiography. Angiology 2014; [pii]10.1177/0003319714520954