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The following is a summary of “Neutrophil-to-lymphocyte ratio as a predictor for early mortality in older patients requiring hemodialysis; insights for hemodialysis access planning,” published in the January 2025 issue of Nephrology by Kim et al. 

The 2019 guidelines stress dialysis selection based on life expectancy but predicting it during arteriovenous fistula creation is challenging. 

Researchers conducted a prospective study to evaluate if neutrophil-to-lymphocyte, monocyte-to-lymphocyte, and platelet-to-lymphocyte ratios measured before dialysis could predict mortality. 

They analyzed records of 448 patients aged ≥ over 70 who underwent first-time arteriovenous access surgery at 3 hospitals from January 2016 to December 2020. Only those with pre-surgery blood tests were included. Non-survivors were grouped by death within 1 year, and survivors were grouped by death after 1 year. 

The results showed that patients were divided into non-survival (n = 52) and survival (n = 396) groups. Multivariate analysis for 1-year mortality found that the preoperative neutrophil-to-lymphocyte ratio had a 1.15 hazard ratio (HR) (P < 0.001). Cancer (HR 2.50, P = 0.02) and peripheral arterial disease (HR 4.62, P < 0.001) were also risk factors. The preoperative platelet-to-lymphocyte and monocyte-to-lymphocyte ratios were not linked to 1-year mortality. In total mortality analysis, the monocyte-to-lymphocyte ratio showed a 2.74 HR (P = 0.007). 

Investigators found that the neutrophil-to-lymphocyte ratio was a risk factor for 1-year mortality in patients aged ≥70 years. Further research was needed to determine its predictive value for mortality. 

Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03924-0