Hematological Parameters and Clinical Features in Patients with Advanced Chronic Kidney Disease

Diagnostic value of neutrophil-to-lymphocyte ratio, fibrinogen-to-albumin ratio and red blood cell distribution width in tuberculosis combined with other bacterial infections

OBJECTIVE

To investigate the clinical significance of the neutrophil-to-lymphocyte ratio (NLR), fibrinogen-to-albumin ratio (FAR), and red blood cell distribution width (RDW) in pulmonary tuberculosis (PTB) associated with other bacterial lung infections.

METHODS

A total of 74 patients with PTB complicated with other bacterial lung infections, who were admitted to the Sixth People's Hospital of Nantong City (Nantong, China) from January 2021 to December 2023, were included in this study as the PTB with infection complication group. A comparison group of 96 patients with uncomplicated PTB, admitted to the same hospital during the same period, was used as the PTB without infection complication group. The NLR, FAR, and RDW values in peripheral blood were determined and compared between the two groups. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of these indicators for early detection of PTB complicated with other bacterial infections.

RESULTS

The NLR, FAR, and RDW values were significantly higher in the PTB with infection complication group compared to the PTB without infection complication group, with differences reaching statistical significance (P < 0.05). NLR value showed a positive correlation with white blood cell count, C-reactive protein levels, and D-dimer levels. ROC curve analysis indicated that the area under the curve (AUC) values for diagnosing PTB with bacterial infection using blood NLR, FAR, and RDW were 0.861, 0.818, and 0.799, respectively. The combined AUC value of these three indicators was 0.982. The validation results showed that the diagnostic sensitivity (98.6%) and specificity (89.58%) of the combination of NLR, FAR, and RDW were higher than those of each indicator alone.

CONCLUSION

The combined assessment of blood NLR, FAR, and RDW values has high clinical diagnostic value for diagnosing PTB complicated with other bacterial infections.

Neutrophil-to-lymphocyte ratio as a novel predictor of sarcopenia in maintenance hemodialysis patients: a cross-sectional study exploring associations across body composition categories

BACKGROUND

Sarcopenia is prevalent among hemodialysis patients and is associated with poor outcomes. The neutrophil-to-lymphocyte ratio (NLR), an easily obtainable marker of inflammation, may predict sarcopenia risk. This study aimed to investigate the association between NLR and sarcopenia risk in maintenance hemodialysis patients, examining this association in the context of obesity.

METHODS

This cross-sectional study included 411 maintenance hemodialysis patients. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria-2019 (AWGS 2019). Body composition was assessed using bioelectrical impedance analysis. Logistic regression models examined associations between NLR and sarcopenia risk, adjusting for potential confounders. Analyses were stratified by obesity status.

RESULTS

The prevalence of sarcopenia was 51% (95% CI: 45.1-54.9%), with 37.2% classified as sarcopenic non-obese and 13.6% as sarcopenic obese. In fully adjusted models, each unit increase in NLR was associated with 10% higher odds of sarcopenia overall (OR 1.10, 95% CI: 1.00-1.21, p = 0.048). This association remained significant in sarcopenic obese patients (OR 1.15, 95% CI: 1.00-1.32, p = 0.049). Patients in the highest NLR tertile had 1.95 times higher odds of sarcopenia compared to the lowest tertile (95% CI: 1.12-3.40, p = 0.018), with a significant trend across tertiles (p-trend = 0.015).

CONCLUSIONS

NLR is independently associated with sarcopenia risk in hemodialysis patients, including those with obesity. These findings suggest NLR could serve as a simple, cost-effective tool for identifying hemodialysis patients at high risk of sarcopenia, potentially facilitating early intervention strategies.

Efficacy of Hypoxia-Inducible Factor Prolyl-Hydroxylase Inhibitors in Renal Anemia: Enhancing Erythropoiesis and Long-Term Outcomes in Patients with Chronic Kidney Disease

BACKGROUND/OBJECTIVES

Renal anemia is one of the major complications associated with chronic kidney disease (CKD). Erythropoietin-stimulating agents (ESAs) are commonly used; however, some patients exhibit resistance. Hypoxia-inducible factor prolyl-hydroxylase inhibitors (HIF-PHIs) have emerged as a novel treatment for renal anemia, enhancing erythropoiesis and iron metabolism.

METHODS

We retrospectively analyzed laboratory data related to erythropoiesis from 105 patients with CKD before and after treatment with HIF-PHI or ESA. The dialysis initiation and mortality rates were also assessed over a median follow-up of 614 days.

RESULTS

HIF-PHI and ESA significantly increased the hemoglobin levels within 6 months of treatment (9.5 ± 1.0 to 10.7 ± 1.1, p < 0.01, and 9.9 ± 1.5 to 10.7 ± 1.2 g/dL, p < 0.01, respectively). The HIF-PHI group demonstrated a significant decrease in red cell distribution width (14.5 ± 1.9% to 13.8 ± 1.4%, p < 0.01), suggesting improved erythropoiesis, and exhibited a lower cumulative incidence of outcomes. The aged-adjusted multivariate analysis confirmed the independent association between HIF-PHI treatment and reduced risk of cumulative outcome (p = 0.042).

CONCLUSIONS

HIF-PHIs can serve as an alternative to ESA for managing renal anemia in CKD, improving both hematological parameters and long-term outcomes.

Mendelian randomization analysis revealed that albuminuria is the key factor affecting socioeconomic status in CKD patients

Previous studies indicate a strong correlation between the incidence of chronic kidney disease (CKD) and lower economic status. However, these studies often struggle to delineate a clear cause-effect relationship, leaving healthcare providers uncertain about how to manage kidney disease in a way that improves patients' financial outcomes. Our study aimed to explore and establish a causal relationship between CKD and socioeconomic status, identifying critical influencing factors. We utilized summary meta-analysis data from the CKDGen Consortium and UK Biobank. Genetic variants identified from these sources served as instrumental variables (IVs) to estimate the association between CKD and socioeconomic status. The presence or absence of CKD, estimated glomerular filtration rate (eGFR), and albuminuria were used as exposures, while income and regional deprivation were analyzed as outcomes. We employed the R packages 'TwoSampleMR' and 'Mendelianrandomization' to conduct both univariable and multivariable Mendelian randomization (MR) analyses, assessing for potential pleiotropy and heterogeneity. Our univariable MR analysis revealed a significant causal relationship between high levels of albuminuria and lower income (OR = 0.84, 95% CI: 0.73-0.96, p = 0.013), with no significant pleiotropy detected. In the multivariable MR analysis, both CKD (OR = 0.867, 95% CI: 0.786-0.957, p = 0.0045) and eGFR (OR = 0.065, 95% CI: 0.010-0.437, p = 0.0049) exhibited significant effects on income. This study underscores that higher albuminuria levels in CKD patients are associated with decreased income and emphasizes the importance of effective management and treatment of albuminuria in CKD patients to mitigate both social and personal economic burdens.

Red blood cell distribution width at admission predicts outcome in critically ill patients with kidney failure: a retrospective cohort study based on the MIMIC-IV database

PURPOSE

We aimed to explore whether red blood cell distribution width (RDW) could serve as a biomarker to predict outcomes in critically ill patients with kidney failure in this study.

MATERIALS AND METHODS

This retrospective study was conducted with the Medical Information Mart for Intensive Care IV (MIMIC-IV).A total of 674 patients were divided into three groups based on tertiles of RDW. We used the generalized additive model, Kaplan-Meier curve, and Cox proportional hazards models to evaluate the association between RDW and clinical outcomes. We then performed subgroup analyses to investigate the stability of the associations between RDW and all-cause mortality.

RESULTS

Nonlinear and J-shaped curves were observed in the generalized additive model. Kaplan-Meier analysis showed that patients with elevated RDW had a lower survival rate. The Cox regression model indicated that high levels of RDW were most closely associated with ICU mortality and 30-day mortality (HR = 4.71, 95% CI: 1.69-11.64 and HR = 6.62, 95% CI: 2.84-15.41). Subgroup analyses indicated that the associations between RDW and all-cause mortality were stable.

CONCLUSIONS

Elevated levels of RDW were associated with an increased risk of all-cause mortality, and RDW could be an independent prognostic factor for kidney failure.

Association of mean platelet volume/lymphocyte ratio with inflammation in non-dialysis patients with chronic kidney disease stages 1-4: A retrospective study

Objective

The mean platelet volume/ratio (MPVLR) is recognized as a novel marker of inflammation. We evaluated whether the MPVLR is associated with inflammation in non-dialysis patients with chronic kidney disease (CKD) stages 1-4.

Methods

A total of 402 non-dialysis patients with CKD stages 1-4 were included. The indicators of hematological, renal function (urea, serum creatinine [Scr], estimated glomerular filtration rate [eGFR], and urine albumin to creatinine ratio [ACR]) and the markers of inflammation (high-sensitivity C-reactive protein [hsCRP] and fibrinogen [FIB]) were recorded. The MPVLR values at different CKD stages were analyzed. Next, based on the absence (hsCRP level < 5 mg/L) and presence (hsCRP level > 5 mg/L) of inflammation, the patients were categorized, and the differences in indices between the two groups were observed. The patients were divided into two groups based on the median MPVLR value (6.39) at admission. The laboratory indices of patients with CKD were compared. Simultaneously, a correlation analysis was performed to identify the association between the MPVLR and each parameter. A binary logistic regression analysis was performed to test whether the MPVLR was associated independently with the presence of inflammation in non-dialysis patients with CKD. The receiver operating characteristic (ROC) curve was used to analyzed diagnostic performance of the MPVLR in evaluating the inflammation of non-dialysis patients with CKD stages 1-4.

Results

The MPVLR was higher in patients with CKD stages 3-4 than in those with CKD stages 1 and 2. Significant differences in urea, Scr, eGFR, ACR, lymphocyte (LYM), red blood cell (RBC), hemoglobin (HGB), RBC distribution width (RDW-CV), MPVLR, and FIB values were observed between the groups with and without inflammation. The patients with a higher MPVLR had higher urea, Scr, ACR, WBC, neutrophils (NEU), RDW-CV, platelet distribution width (PDW), mean platelet volume (MPV), and hsCRP values and lower eGFR, LYM, RBC, HGB, and platelet (PLT) values. The MPVLR showed a positive correlation with age, urea, Scr, WBC, NEU, RDW-CV, PDW, MPV, and hsCRP values and a negative correlation with the eGFR, LYM, RBC, HGB, and PLT values. A logistic analysis revealed that the MPVLR was associated independently with the presence of inflammation in non-dialysis patients with CKD, after adjustment for the confounding factors (odds ratio = 1.020; P = 0.024). Furthermore, MPVLR exhibited a modest diagnostic performance for the assessment of inflammation in non-dialysis patients with CKD stages 1-4, with an area under the curve (AUC) of 0.706, and the sensitivity, specificity being 46.2% and 83.2%, respectively.

Conclusions

The MPVLR was associated independently with the presence of inflammation in non-dialysis patients with CKD and may be useful for monitoring inflammation.

Drug-containing serum of rhubarb-astragalus capsule inhibits the epithelial-mesenchymal transformation of HK-2 by downregulating TGF-β1/p38MAPK/Smad2/3 pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Rheum palmatum L; Astragalus membranaceus (Fisch.), is referred to as 'Dahuang, Huangqi' in China. As an important medicinal plant, the rhizome of rhubarb and astragalus is traditionally used in the treatment of kidney diseases associated with renal failure, inflammation and tumors.

AIM OF THE STUDY

This study aimed to investigate the effect of a drug-containing serum of rhubarb-astragalus capsules (composed of rhubarb and astragalus) and to elucidate its mechanism in the epithelial-mesenchymal transformation of renal tubular epithelial cells.

MATERIALS AND METHODS

Epithelial-mesenchymal transformation (EMT) of HK-2 cells was induced by TGF-β1, and rhubarb-astragalus and losartan drug-containing serum from rats, as well as SB203580 (a specific inhibitor of p38 MAPK), were used. High-performance liquid chromatography analysis was performed to determine the main components of the drug-containing serum of rhubarb-astragalus from rats. Western blotting and immunofluorescence analysis were used to determine the levels of protein expression, and real-time quantitative PCR analysis was used to detect the levels of gene expression.

RESULTS

The drug-containing serum of rhubarb-astragalus contained emodin (0.36 μg/ml) and danthraquinone (0.96 μg/ml). Rhubarb-astragalus significantly decreased the protein expression levels of α-SMA, FN, vimentin and N-cadherin in HK-2 cells that were increased by TGF-β1, while it significantly increased the E-cadherin protein expression level that was decreased by TGF-β1. Rhubarb-astragalus also significantly decreased the protein expression levels of TGF-β1 and p38 MAPK and the mRNA expression levels of α-SMA, vimentin, TGF-β1, p38 MAPK, Smad2 and Smad3 in HK-2 cells that were increased by TGF-β1. It is worth noting that SB203580 (a p38 MAPK inhibitor) had similar effects as rhubarb-astragalus in this study.

CONCLUSION

The drug-containing serum of rhubarb-astragalus can inhibit EMT in HK-2 cells by downregulating the TGF-β1/p38 MAPK/Smad2/3 pathway.