Association of neutrophil-to-lymphocyte ratio and risk of cardiovascular or all-cause mortality in chronic kidney disease: a meta-analysis

Abstract Background Cardiovascular disease is an important driver of the increased mortality associated with chronic kidney disease (CKD). Higher left ventricular mass (LVM) predicts increased risk of adverse cardiovascular outcomes and total mortality, but previous reviews have shown no clear association between intervention-induced LVM change and all-cause or cardiovascular mortality in CKD. Methods The primary objective of this meta-analysis was to investigate whether treatment-induced reductions in LVM over periods ≥ 12 months were associated with all-cause mortality in patients with CKD. Cardiovascular mortality was investigated as a secondary outcome. Measures of association in the form of relative risks (RRs) with associated variability and precision (95% confidence intervals [CIs]) were extracted directly from each study, when reported, or were calculated based on the published data, if possible, and pooled RR estimates were determined. Results The meta-analysis included 38 trials with duration ≥ 12 months: 6 of erythropoietin stimulating agents treating to higher vs. lower hemoglobin targets, 10 of renin-angiotensin-aldosterone system inhibitors vs. placebo or another blood pressure lowering agent, 14 of modified hemodialysis regimens, and 8 of other types of interventions. All-cause mortality was reported in 116/2385 (4.86%) subjects in intervention groups and 161/2404 (6.70%) subjects in control groups. The pooled RR estimate of the 24 trials ≥ 12 months with ≥ 1 event in ≥ 1 group was 0.72 (95% CI 0.57 to 0.91, p = 0.005), with little heterogeneity across studies. Directionalities of the associations in intervention subgroups were the same. Sensitivity analyses of ≥ 6 months (31 trials), ≥ 9 months (26 trials), and > 12 months (9 trials), and including studies with no events in either group, demonstrated similar risk reductions to the primary analysis. The point estimate for cardiovascular mortality was similar to all-cause mortality, but not statistically significant: RR 0.66, 95% CI 0.38 to 1.15. Conclusions These results suggest that LVM regression may be a useful surrogate marker for benefits of interventions intended to reduce mortality risk in patients with CKD.

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Lower circulating soluble Klotho level is associated with increased risk of all-cause mortality in chronic kidney disease patients: a systematic review and meta-analysis

International Urology and Nephrology ◽

10.1007/s11255-020-02510-1 ◽

2020 ◽

Vol 52 (8) ◽

pp. 1543-1550

Author(s):

Nipith Charoenngam ◽

Ben Ponvilawan ◽

Patompong Ungprasert

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Meta Analysis ◽

Increased Risk ◽

All Cause Mortality

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Comparison between Intravenous Iron and Oral Iron Preparations for the Treatment of Anemia of Chronic Kidney Disease - A Systematic Review and Meta-Analysis

Blood ◽

10.1182/blood.v110.11.3748.3748 ◽

2007 ◽

Vol 110 (11) ◽

pp. 3748-3748

Author(s):

Anat Gafter-Gvili ◽

Benaya Rozen-Zvi ◽

Mical Paul ◽

Leonard Leibovici ◽

Gafter Uzi ◽

...

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Meta Analysis ◽

Oral Iron ◽

Dialysis Patients ◽

Significant Difference ◽

All Cause Mortality ◽

Iron Preparation ◽

Iv Iron

Abstract Background: There is confounding data regarding the best method of iron supplementation in chronic kidney disease (CKD), without a consistent approach in clinical practice. Objectives: To evaluate the efficacy and safety of intravenous (IV) iron versus oral iron in patients treated for anemia of CKD. Methods: Systematic review and meta-analysis of randomized controlled trials comparing IV iron preparation with oral iron preparation for the treatment of anemia in patients with CKD (stage III, IV and V). The Cochrane Library, MEDLINE, conference proceedings and references were searched until 2007. Primary outcomes: absolute hemoglobin (Hb) level or change in Hb level from baseline at two months or at end of study; all-cause mortality. Secondary outcomes: need for renal replacement therapy (RRT) in predialysis patient and adverse events. Weighted mean differences (WMD) for outcomes with continuous variables and relative risks (RR) for dichotomous outcomes with 95% confidence intervals (CI) were estimated and pooled. Results: Our search yielded 11 trials which compared IV iron preparations (iron sucrose, iron gluconate or iron dextran) to oral iron. Compared to oral iron, there was a significant rise in Hb level in the IV iron treated hemodialysis patients (WMD 1.17; 95%CI 0.19–2.15, fig). Significant heterogeneity was observed due to different baseline Hb values and baseline iron status, different dosages of oral iron, and different dosages of erythropoiesis stimulating agents (ESA). For predialysis patients, there was a small but significant difference in the Hb level favoring the IV iron group (WMD 0.28; 95% CI 0.15–0.4, fig). For both groups effect estimates were not influenced by ESA administration. In predialysis patients, there was no significant difference in the risk for requiring RRT during the trial between the different groups (RR 0.63; 95%CI 0.25–1.65). Data on all-cause mortality were sparse (RR 0.54; 95%CI 0.09–3.13, 3 trials) and there was no difference in adverse events (RR 0.9; 95%CI 0.65–1.24) between the IV and oral treated patients. However, discontinuations of treatment were more common (RR 3.27; 95%CI 1.15–9.26) for the IV iron treated patients. Conclusions: Our review demonstrates that dialysis patients treated with IV iron have better Hb response than patients treated with oral iron. For predialysis patients, this effect is very small. IV iron should be preferred in the treatment of anemia in dialysis patients. In predialysis patients the slight advantage in Hb response should be weighed against the inconvenience and cost of IV iron treatment.

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Markers of Atherosclerosis in Hypertensive Patients with Less Advanced Chronic Kidney Disease

Acta Medica Marisiensis ◽

10.2478/amma-2019-0022 ◽

2019 ◽

Vol 65 (3) ◽

pp. 91-96

Author(s):

Claudia Floriana Suciu ◽

Andreea Varga ◽

Corneliu Florin Buicu ◽

Ioan Tilea

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Aortic Arch ◽

Laboratory Data ◽

Hypertensive Heart Disease ◽

Neutrophil To Lymphocyte Ratio ◽

Advanced Chronic Kidney Disease ◽

Hypertensive Patients ◽

Lymphocyte Ratio ◽

Aortic Arch Calcification

AbstractObjective: Our study aimed to validate the neutrophil-to-lymphocyte ratio (NLR) as a marker for aortic arch calcification in hypertensive patients with less advanced chronic kidney disease (CKD).Methods: A number of forty-four hypertensive patients with chronic kidney disease (categories G3a and G3b – 2012 KDIGO nomenclature) were included in the study. Considering the presence of aortic arch calcification (AAC) on chest X-ray, the study population was divided into two groups: 27 patients AAC present and seventeen without aortic arch calcification. Laboratory data were collected for each patient and NLR was computed. Comorbidities were also recorded: stable coronary artery disease, lower extremity arterial disease and hypertensive heart disease.Results: A positive correlation between neutrophil-to-lymphocyte ratio and aortic arch calcification in hypertensive CKD patients was identified. Furthermore, advanced age, increased alkaline phosphatase and increased erythrocyte sedimentation rate had a positive association with aortic arch calcification. We found no statistical correlation between neutrophil-to-lymphocyte ratio and other laboratory features in both groups of patients.Conclusions: Neutrophil-to-lymphocyte ratio may be viewed as a potential risk factor for vascular calcification in patients with moderate chronic kidney disease; nevertheless, future extensive studies are necessary. In the management of hypertensive patients, general medicine might particularly benefit of this simple, readily available inflammatory marker.

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Prognostic Value of Soluble Suppression of Tumorigenicity 2 in Chronic Kidney Disease Patients: A Meta-Analysis

Disease Markers ◽

10.1155/2021/8881393 ◽

2021 ◽

Vol 2021 ◽

pp. 1-11

Author(s):

Guangying Guo ◽

Aoran Huang ◽

Xin Huang ◽

Tianhua Xu ◽

Li Yao

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Sample Size ◽

Subgroup Analysis ◽

Meta Analysis ◽

Prognostic Role ◽

Increased Risk ◽

All Cause Mortality ◽

Cvd Mortality

Objective. Previous studies have controversial results about the prognostic role of soluble suppression of tumorigenicity 2 (sST2) in chronic kidney disease (CKD). Therefore, we conduct this meta-analysis to access the association between sST2 and all-cause mortality, cardiovascular disease (CVD) mortality, and CVD events in patients with CKD. Methods. The publication studies on the association of sST2 with all-cause mortality, CVD mortality, and CVD events from PubMed and Embase were searched through August 2020. We pooled the hazard ratio (HR) comparing high versus low levels of sST2 and subgroup analysis based on treatment, continent, and diabetes mellitus (DM) proportion, and sample size was also performed. Results. There were 15 eligible studies with 11,063 CKD patients that were included in our meta-analysis. Elevated level of sST2 was associated with increased risk of all-cause mortality (HR 2.05; 95% confidence interval (CI), 1.51–2.78), CVD mortality (HR 1.68; 95% CI, 1.35–2.09), total CVD events (HR 1.88; 95% CI, 1.26–2.80), and HF (HR 1.35; 95% CI, 1.11–1.64). Subgroup analysis based on continent, DM percentage, and sample size showed that these factors did not influence the prognostic role of sST2 levels to all-cause mortality. Conclusions. Our results show that high levels of sST2 could predict the all-cause mortality, CVD mortality, and CVD events in CKD patients.

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