ADMA, neutrophil to lymphocyte, platelet to lymphocyte ratios and phase angle: effects on inflammation and nutrition in hemodialysis patients

Bahar Gürlek Demirci; Mine Şebnem Karakan

doi:10.18621/eurj.1404126

Araştırma Makalesi

ADMA, neutrophil to lymphocyte, platelet to lymphocyte ratios and phase angle: effects on inflammation and nutrition in hemodialysis patients

Yıl 2024, EARLY ONLINE, 1 - 6

Bahar Gürlek Demirci Mine Şebnem Karakan

https://doi.org/10.18621/eurj.1404126

Öz

Objectives: Neutrophil/lymphocyte ration (NLR) and platelet/lymphocyte ratio (PLR) levels can be used as systemic infallamotory parameters. Asymmetric dimethyl arginine (ADMA) inhibits endothelial nitric oxide synthase. Phase Angle (PhA) is a potential paremeter to screen for inflammatory abnormalities. In present study we aimed to determine the relations between NLR, PLR, ADMA, and PhA in terms of early markers for nutritonal status in addition to their well-known role in inflammation.

Methods: A total of 89 patients undergoing maintenance hemodialysis 3 days a week at least 6 months were enrolled. To assess nutritional status, we performed the dietary questionnaire and mini nutritional assessment score (MNAS). ADMA was measured by ELISA. NLR and PLR are calculated from monthly complete blood count tests. Patients were divided into 2 groups accordng to NLR levels as group 1 (NLR≥4.6; n=48) ve and group 2 (NLR<4.6, n=41).

Results: The mean ADMA level was 0.03±0.01 µmol/L, the mean PhA was 7.2±1.1º. In subgroup analysis, MNAS, albumin levels and phase angle of patients in group 1 were lower and CRP, PLR, ADMA levels were higher when compared to group 2. In correlation analysis, NLO was positively correlated with PLR, CRP and ADMA however negatively correlated with albumin and PhA levels. In regression analysis, NLR, PLR and ADMA were detected as independent predictors of MNAS.

Conclusion: In conclusion our study suggests that NLR, PLR and ADMA are independent predictors for nutritional status and inflammation in patients ongoing hemodialysis.

Anahtar Kelimeler

ADMA neutrophil, lymphocyte, platelet, phase angle, inflammation, nutrition, hemodialysis

Kaynakça

1. Kramer A, Pippias M, Noordzij M, et al. The European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report 2016: a summary. Clin Kidney J. 2019;12(5):702-720. doi: 10.1093/ckj/sfz011.
2. Maggio M, Lauretani F. Prevalence, incidence, and clinical impact of cognitive-motoric risk syndrome in Europe, USA, and Japan: facts and numbers update 2019. J Cachexia Sarcopenia Muscle. 2019;10(5):953-955. doi: 10.1002/jcsm.12476.
3. Espahbodi F, Khoddad T, Esmaeili L. Evaluation of malnutrition and its association with biochemical parameters in patients with end stage renal disease undergoing hemodialysis using subjective global assessment. Nephrourol Mon. 2014;6(3):e16385. doi: 10.5812/numonthly.16385.
4. Chertow GM, Johansen KL, Lew N, Lazarus JM, Lowrie EG. Vintage, nutritional status, and survival in hemodialysis patients. Kidney Int. 2000;57(3):1176-1181. doi: 10.1046/j.1523-1755.2000.00945.x.
5. Wang J, Xu MC, Huang LJ, Li B, Yang L, Deng X. Value of neutrophil-to-lymphocyte ratio for diagnosing sarcopenia in patients undergoing maintenance hemodialysis and efficacy of Baduanjin exercise combined with nutritional support. Front Neurol. 2023;14:1072986. doi: 10.3389/fneur.2023.1072986.
6. Pavan A, Calvetti L, Dal Maso A, et al. Peripheral Blood Markers Identify Risk of Immune-Related Toxicity in Advanced Non-Small Cell Lung Cancer Treated with Immune-Checkpoint Inhibitors. Oncologist. 2019;24(8):1128-1136. doi: 10.1634/theoncologist.2018-0563.
7. Bonaventura A, Carbone F, Liberale L, et al. Platelet-to-lymphocyte ratio at the time of carotid endarterectomy is associated with acute coronary syndrome occurrence. J Cardiovasc Med (Hagerstown). 2020;21(1):80-82. doi: 10.2459/JCM.0000000000000869.
8. Chen M, Zheng SH, Yang M, Chen ZH, Li ST. The diagnostic value of preoperative inflammatory markers in craniopharyngioma: a multicenter cohort study. J Neurooncol. 2018;138(1):113-122. doi: 10.1007/s11060-018-2776-x.
9. Maraj M, Kuśnierz-Cabala B, Dumnicka P, et al. Malnutrition, Inflammation, Atherosclerosis Syndrome (MIA) and Diet Recommendations among End-Stage Renal Disease Patients Treated with Maintenance Hemodialysis. Nutrients. 2018;10(1):69. doi: 10.3390/nu10010069.
10. Shafi T, Hostetter TH, Meyer TW, et al. Serum Asymmetric and Symmetric Dimethylarginine and Morbidity and Mortality in Hemodialysis Patients. Am J Kidney Dis. 2017;70(1):48-58. doi: 10.1053/j.ajkd.2016.10.033.
11. da Silva BR, Gonzalez MC, Cereda E, Prado CM. Exploring the potential role of phase angle as a marker of oxidative stress: A narrative review. Nutrition. 2022;93:111493. doi: 10.1016/j.nut.2021.111493.
12. Vellas B, Guigoz Y, Garry PJ, et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999;15(2):116-122. doi: 10.1016/s0899-9007(98)00171-3.
13. Goswami KK, Ghosh T, Ghosh S, Sarkar M, Bose A, Baral R. Tumor promoting role of anti-tumor macrophages in tumor microenvironment. Cell Immunol. 2017;316:1-10. doi: 10.1016/j.cellimm.2017.04.005.
14. Oliva-Damaso E, Oliva-Damaso N, Rodriguez-Esparragon F, et al. Asymmetric (ADMA) and Symmetric (SDMA) Dimethylarginines in Chronic Kidney Disease: A Clinical Approach. Int J Mol Sci. 2019;20(15):3668. doi: 10.3390/ijms20153668.
15. Matsuzawa R, Yamamoto S, Suzuki Y, et al. The clinical applicability of ultrasound technique for diagnosis of sarcopenia in hemodialysis patients. Clin Nutr. 2021;40(3):1161-1167. doi: 10.1016/j.clnu.2020.07.025.
16. Pedersen BK. Muscles and their myokines. J Exp Biol. 2011 Jan 15;214(Pt 2):337-346. doi: 10.1242/jeb.048074.
17. Kalantar-Zadeh K, Kopple JD, Humphreys MH, Block G. Comparing outcome predictability of markers of malnutrition-inflammation complex syndrome in haemodialysis patients. Nephrol Dial Transplant. 2004;19(6):1507-1519. doi: 10.1093/ndt/gfh143.
18. Malhotra R, Marcelli D, von Gersdorff G, et al. Relationship of Neutrophil-to-Lymphocyte Ratio and Serum Albumin Levels with C-Reactive Protein in Hemodialysis Patients: Results from 2 International Cohort Studies. Nephron. 2015;130(4):263-270. doi: 10.1159/000437005.
19. Diaz-Martinez J, Campa A, Delgado-Enciso I, et al. The relationship of blood neutrophil-to-lymphocyte ratio with nutrition markers and health outcomes in hemodialysis patients. Int Urol Nephrol. 2019;51(7):1239-1247. doi: 10.1007/s11255-019-02166-6.
20. Wang J, Xu MC, Huang LJ, Li B, Yang L, Deng X. Value of neutrophil-to-lymphocyte ratio for diagnosing sarcopenia in patients undergoing maintenance hemodialysis and efficacy of Baduanjin exercise combined with nutritional support. Front Neurol. 2023;14:1072986. doi: 10.3389/fneur.2023.1072986.
21. Liaw FY, Huang CF, Chen WL, et al. Higher Platelet-to-Lymphocyte Ratio Increased the Risk of Sarcopenia in the Community-Dwelling Older Adults. Sci Rep. 2017;7(1):16609. doi: 10.1038/s41598-017-16924-y.
22. Akbas EM, Hamur H, Demirtas L, Bakirci EM, Ozcicek A, Ozcicek F, Kuyrukluyildiz U, Turkmen K. Predictors of epicardial adipose tissue in patients with type 2 diabetes mellitus. Diabetol Metab Syndr. 2014 May 9;6:55. doi: 10.1186/1758-5996-6-55. PMID: 24822086; PMCID: PMC4018267.
23. Li P, Xia C, Liu P, et al. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in evaluation of inflammation in non-dialysis patients with end-stage renal disease (ESRD). BMC Nephrol. 2020;21(1):511. doi: 10.1186/s12882-020-02174-0.
24. Okyay GU, Inal S, Oneç K, et al. Neutrophil to lymphocyte ratio in evaluation of inflammation in patients with chronic kidney disease. Ren Fail. 2013;35(1):29-36. doi: 10.3109/0886022X.2012.734429.
25. Behairy M, Shawky S, Bawady S, El Kezza G, Ahmed F. Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Evaluation of Inflammation and Nutritional Status in Chronic Kidney Disease Patients. Egyptian J Hosp Med. 2022;89(1):5814-5823. : 10.21608/ejhm.2022.266654.
26. Shafi T, Hostetter TH, Meyer TW, et al. Serum Asymmetric and Symmetric Dimethylarginine and Morbidity and Mortality in Hemodialysis Patients. Am J Kidney Dis. 2017;70(1):48-58. doi: 10.1053/j.ajkd.2016.10.033.
27. Zoccali C, Bode-Böger S, Mallamaci F, et al. Plasma concentration of asymmetrical dimethylarginine and mortality in patients with end-stage renal disease: a prospective study. Lancet. 2001;358(9299):2113-2117. doi: 10.1016/s0140-6736(01)07217-8.
28. Rinaldi S, Gilliland J, O'Connor C, Chesworth B, Madill J. Is phase angle an appropriate indicator of malnutrition in different disease states? A systematic review. Clin Nutr ESPEN. 2019;29:1-14. doi: 10.1016/j.clnesp.2018.10.010.
29. Norman K, Stobäus N, Pirlich M, Bosy-Westphal A. Bioelectrical phase angle and impedance vector analysis--clinical relevance and applicability of impedance parameters. Clin Nutr. 2012;31(6):854-861. doi: 10.1016/j.clnu.2012.05.008.

Yıl 2024, EARLY ONLINE, 1 - 6

Bahar Gürlek Demirci Mine Şebnem Karakan

https://doi.org/10.18621/eurj.1404126

Öz

Kaynakça

1. Kramer A, Pippias M, Noordzij M, et al. The European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report 2016: a summary. Clin Kidney J. 2019;12(5):702-720. doi: 10.1093/ckj/sfz011.
2. Maggio M, Lauretani F. Prevalence, incidence, and clinical impact of cognitive-motoric risk syndrome in Europe, USA, and Japan: facts and numbers update 2019. J Cachexia Sarcopenia Muscle. 2019;10(5):953-955. doi: 10.1002/jcsm.12476.
3. Espahbodi F, Khoddad T, Esmaeili L. Evaluation of malnutrition and its association with biochemical parameters in patients with end stage renal disease undergoing hemodialysis using subjective global assessment. Nephrourol Mon. 2014;6(3):e16385. doi: 10.5812/numonthly.16385.
4. Chertow GM, Johansen KL, Lew N, Lazarus JM, Lowrie EG. Vintage, nutritional status, and survival in hemodialysis patients. Kidney Int. 2000;57(3):1176-1181. doi: 10.1046/j.1523-1755.2000.00945.x.
5. Wang J, Xu MC, Huang LJ, Li B, Yang L, Deng X. Value of neutrophil-to-lymphocyte ratio for diagnosing sarcopenia in patients undergoing maintenance hemodialysis and efficacy of Baduanjin exercise combined with nutritional support. Front Neurol. 2023;14:1072986. doi: 10.3389/fneur.2023.1072986.
6. Pavan A, Calvetti L, Dal Maso A, et al. Peripheral Blood Markers Identify Risk of Immune-Related Toxicity in Advanced Non-Small Cell Lung Cancer Treated with Immune-Checkpoint Inhibitors. Oncologist. 2019;24(8):1128-1136. doi: 10.1634/theoncologist.2018-0563.
7. Bonaventura A, Carbone F, Liberale L, et al. Platelet-to-lymphocyte ratio at the time of carotid endarterectomy is associated with acute coronary syndrome occurrence. J Cardiovasc Med (Hagerstown). 2020;21(1):80-82. doi: 10.2459/JCM.0000000000000869.
8. Chen M, Zheng SH, Yang M, Chen ZH, Li ST. The diagnostic value of preoperative inflammatory markers in craniopharyngioma: a multicenter cohort study. J Neurooncol. 2018;138(1):113-122. doi: 10.1007/s11060-018-2776-x.
9. Maraj M, Kuśnierz-Cabala B, Dumnicka P, et al. Malnutrition, Inflammation, Atherosclerosis Syndrome (MIA) and Diet Recommendations among End-Stage Renal Disease Patients Treated with Maintenance Hemodialysis. Nutrients. 2018;10(1):69. doi: 10.3390/nu10010069.
10. Shafi T, Hostetter TH, Meyer TW, et al. Serum Asymmetric and Symmetric Dimethylarginine and Morbidity and Mortality in Hemodialysis Patients. Am J Kidney Dis. 2017;70(1):48-58. doi: 10.1053/j.ajkd.2016.10.033.
11. da Silva BR, Gonzalez MC, Cereda E, Prado CM. Exploring the potential role of phase angle as a marker of oxidative stress: A narrative review. Nutrition. 2022;93:111493. doi: 10.1016/j.nut.2021.111493.
12. Vellas B, Guigoz Y, Garry PJ, et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999;15(2):116-122. doi: 10.1016/s0899-9007(98)00171-3.
13. Goswami KK, Ghosh T, Ghosh S, Sarkar M, Bose A, Baral R. Tumor promoting role of anti-tumor macrophages in tumor microenvironment. Cell Immunol. 2017;316:1-10. doi: 10.1016/j.cellimm.2017.04.005.
14. Oliva-Damaso E, Oliva-Damaso N, Rodriguez-Esparragon F, et al. Asymmetric (ADMA) and Symmetric (SDMA) Dimethylarginines in Chronic Kidney Disease: A Clinical Approach. Int J Mol Sci. 2019;20(15):3668. doi: 10.3390/ijms20153668.
15. Matsuzawa R, Yamamoto S, Suzuki Y, et al. The clinical applicability of ultrasound technique for diagnosis of sarcopenia in hemodialysis patients. Clin Nutr. 2021;40(3):1161-1167. doi: 10.1016/j.clnu.2020.07.025.
16. Pedersen BK. Muscles and their myokines. J Exp Biol. 2011 Jan 15;214(Pt 2):337-346. doi: 10.1242/jeb.048074.
17. Kalantar-Zadeh K, Kopple JD, Humphreys MH, Block G. Comparing outcome predictability of markers of malnutrition-inflammation complex syndrome in haemodialysis patients. Nephrol Dial Transplant. 2004;19(6):1507-1519. doi: 10.1093/ndt/gfh143.
18. Malhotra R, Marcelli D, von Gersdorff G, et al. Relationship of Neutrophil-to-Lymphocyte Ratio and Serum Albumin Levels with C-Reactive Protein in Hemodialysis Patients: Results from 2 International Cohort Studies. Nephron. 2015;130(4):263-270. doi: 10.1159/000437005.
19. Diaz-Martinez J, Campa A, Delgado-Enciso I, et al. The relationship of blood neutrophil-to-lymphocyte ratio with nutrition markers and health outcomes in hemodialysis patients. Int Urol Nephrol. 2019;51(7):1239-1247. doi: 10.1007/s11255-019-02166-6.
20. Wang J, Xu MC, Huang LJ, Li B, Yang L, Deng X. Value of neutrophil-to-lymphocyte ratio for diagnosing sarcopenia in patients undergoing maintenance hemodialysis and efficacy of Baduanjin exercise combined with nutritional support. Front Neurol. 2023;14:1072986. doi: 10.3389/fneur.2023.1072986.
21. Liaw FY, Huang CF, Chen WL, et al. Higher Platelet-to-Lymphocyte Ratio Increased the Risk of Sarcopenia in the Community-Dwelling Older Adults. Sci Rep. 2017;7(1):16609. doi: 10.1038/s41598-017-16924-y.
22. Akbas EM, Hamur H, Demirtas L, Bakirci EM, Ozcicek A, Ozcicek F, Kuyrukluyildiz U, Turkmen K. Predictors of epicardial adipose tissue in patients with type 2 diabetes mellitus. Diabetol Metab Syndr. 2014 May 9;6:55. doi: 10.1186/1758-5996-6-55. PMID: 24822086; PMCID: PMC4018267.
23. Li P, Xia C, Liu P, et al. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in evaluation of inflammation in non-dialysis patients with end-stage renal disease (ESRD). BMC Nephrol. 2020;21(1):511. doi: 10.1186/s12882-020-02174-0.
24. Okyay GU, Inal S, Oneç K, et al. Neutrophil to lymphocyte ratio in evaluation of inflammation in patients with chronic kidney disease. Ren Fail. 2013;35(1):29-36. doi: 10.3109/0886022X.2012.734429.
25. Behairy M, Shawky S, Bawady S, El Kezza G, Ahmed F. Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Evaluation of Inflammation and Nutritional Status in Chronic Kidney Disease Patients. Egyptian J Hosp Med. 2022;89(1):5814-5823. : 10.21608/ejhm.2022.266654.
26. Shafi T, Hostetter TH, Meyer TW, et al. Serum Asymmetric and Symmetric Dimethylarginine and Morbidity and Mortality in Hemodialysis Patients. Am J Kidney Dis. 2017;70(1):48-58. doi: 10.1053/j.ajkd.2016.10.033.
27. Zoccali C, Bode-Böger S, Mallamaci F, et al. Plasma concentration of asymmetrical dimethylarginine and mortality in patients with end-stage renal disease: a prospective study. Lancet. 2001;358(9299):2113-2117. doi: 10.1016/s0140-6736(01)07217-8.
28. Rinaldi S, Gilliland J, O'Connor C, Chesworth B, Madill J. Is phase angle an appropriate indicator of malnutrition in different disease states? A systematic review. Clin Nutr ESPEN. 2019;29:1-14. doi: 10.1016/j.clnesp.2018.10.010.
29. Norman K, Stobäus N, Pirlich M, Bosy-Westphal A. Bioelectrical phase angle and impedance vector analysis--clinical relevance and applicability of impedance parameters. Clin Nutr. 2012;31(6):854-861. doi: 10.1016/j.clnu.2012.05.008.

Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	İngilizce
Konular	Nefroloji
Bölüm	Original Article
Yazarlar	Bahar Gürlek Demirci 0000-0003-1680-0005 Mine Şebnem Karakan 0000-0002-7499-1738
Erken Görünüm Tarihi	7 Mayıs 2024
Yayımlanma Tarihi
Gönderilme Tarihi	12 Aralık 2023
Kabul Tarihi	5 Mart 2024
Yayımlandığı Sayı	Yıl 2024 EARLY ONLINE

Kaynak Göster

AMA	Gürlek Demirci B, Karakan MŞ. ADMA, neutrophil to lymphocyte, platelet to lymphocyte ratios and phase angle: effects on inflammation and nutrition in hemodialysis patients. Eur Res J. Published online 01 Mayıs 2024:1-6. doi:10.18621/eurj.1404126

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