Clinical research

Nephrology

Associations between neutrophil/lymphocyte ratio,

platelet/lymphocyte ratio, albuminuria and uric
acid and the estimated glomerular filtration rate in
hypertensive patients with chronic kidney disease
stages 1–3

Nurhayat Ozkan Sevencan, Aysegul Ertinmaz Ozkan

Department of Internal Medicine, Medical Faculty, University of Karabuk, Karabuk, Turkey Corresponding author:
Nurhayat Ozkan Sevencan
Submitted: 3 March 2018 PhD
Accepted: 20 May 2018 Department
of Internal Medicine
Arch Med Sci 2019; 15 (5): 1232–1239 Medical Faculty
DOI: https://doi.org/10.5114/aoms.2018.76262 University of Karabuk
Copyright © 2018 Termedia & Banach 78100 Karabuk, Turkey
Phone/fax: +90 5053961458
E-mail: dr_nurhayat@
Abstract hotmail.com
Introduction: The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte
ratio (PLR), albuminuria and uric acid are known to be independent pre-
dictors of hypertension and cardiovascular mortality. However, to date, no
study has been conducted describing the relationships between the NLR,
PLR and estimated glomerular filtration rate (eGFR) in hypertensive patients
with chronic kidney disease (CKD) who do not require renal replacement
therapy.
Material and methods: This prospective study included 271 patients with
essential hypertension and eGFR ≥ 30 ml/min/1.73 m2. The patients were di-
vided into two groups: those with CKD stages 1 and 2 and those with stage 3.
We used the complete blood count to calculate the NLR and PLR, and we
measured the albuminuria and uric acid levels. Then, we studied their asso-
ciations with the eGFR and their potential uses as independent risk factors
for renal damage.
Results: The NLR, albuminuria and uric acid were higher in patients with
CKD stage 3 than in those with stages 1 and 2 (p = 0.013, p = 0.001 and
p = 0.001, respectively). However, no significant difference was detected
in the PLR. In stage 3 patients, albuminuria and uric acid were found to be
independent risk factors affecting the eGFR (p = 0.042 and p = 0.001, re-
spectively). However, the effects of the NLR and PLR on the eGFR were not
significant (p = 0.104 and p = 0.578, respectively).
Conclusions: The NLR, similar to albuminuria and uric acid, the NLR was
found to be a specific marker for CKD stage 3 patients. However, the NLR
and PLR did not act as independent risk factors affecting the eGFR.

Key words: neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, uric

acid, albuminuria, estimated glomerular filtration rate, chronic kidney
disease.

Introduction
Essential hypertension, also known as primary hypertension, refers to
a condition of high blood pressure without any secondary cause, and it may
result in cardiovascular disease. The aetiology of essential hypertension is
multifactorial, with inflammation being an important factor in its pathogen-
 Associations between neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, albuminuria and uric acid and the estimated glomerular
filtration rate in hypertensive patients with chronic kidney disease stages 1–3

esis [1]. Studies have shown the significant role that of the heart. All of the patients wore light clothing
inflammation plays in the onset and progression of (no tight clothing constricting the arms), and they
cardiovascular and renal diseases [2–6]. were kept in optimal room conditions. At least two
An increased count of leukocytes (and their blood pressure measurements (mean: 2.2 ±0.5
subtypes) is a hallmark of the inflammatory pro- measurements) at 5-min intervals were taken
cess, and it is closely associated with cardiovascu- from each patient from both the arms in mild flex-
lar risk [7]. The neutrophil/lymphocyte ratio (NLR), ion using an aneroid sphygmomanometer (Perfect
which is derived from the leukocyte count, has Aneroid sphygmomanometer; ERKA, Bad Tölz,
been investigated with regard to cardiovascular Germany). The mean of the two readings from the
risk, and it was found to be an important inflam- higher arm side was accepted as the BP. If there
mation marker [8–11]. Similarly, the platelet/lym- was more than a 5 mm Hg difference between
phocyte ratio (PLR) has been shown to be asso- the first and second readings, additional (one or
ciated with important cardiovascular outcomes. two) readings were obtained, and the average of
This is attributed to the increased platelet activa- these multiple readings was used. The SBP was
tion observed in the onset and progression of ath- accepted as the first Korotkoff sound phase, while
erosclerosis [12]. Additionally, serum uric acid and the DBP was the fifth phase (disappearance of
albuminuria, which are independent determinants sounds) to the nearest 2 mm Hg. Three different
of a future increase in the systolic blood pressure, cuff sizes were used in these patients according
may be considered among the independent risk to their arm circumferences (small adult = 12 ×
factors for hypertension, as well as cardiovascular 18 cm, standard adult = 12 × 26 cm and large
and renal damage [13–18]. adult = 12 × 40 cm) [20]. The aneroid sphygmo-
Although the NLR and PLR have been evaluated manometers were calibrated using a standardized
as cardiovascular risk factors in many studies, re- mercury column manometer.
search regarding their associations with renal dam-
age and the estimated glomerular filtration rate Exclusion criteria
(eGFR) is limited [19]. Moreover, to the best of our
knowledge, there have been no studies performed Patients with diabetes mellitus, hematopoietic
in patients with chronic kidney disease (CKD) who system disorders, histories of malignancy and/or
do not require renal replacement therapy. chemotherapy treatment, signs of accompanying
Therefore, in the present study, we investigated infectious diseases, leukocyte disorders (such as
the associations between the NLR, PLR, albumin- an acute infection or chronic inflammatory sta-
uria and serum uric acid and the eGFR. In addition, tus), histories of secondary hypertension, cardiac
we investigated whether the NLR and PLR were in- failure and chronic liver disease, and those who
dependent predictors of renal damage in patients had used glucocorticoid therapy within the last
with essential hypertension and CKD stages 1–3. 3 months were excluded from the study. Com-
prehensive medical history was taken from the
Material and methods patients to exclude secondary hypertension. All
of the patients underwent renal artery Doppler
Design and patients ultrasonography (USG), and the renal resistive
This prospective study included 271 patients indexes were measured to exclude secondary hy-
over 40 years old with essential hypertension and pertension. We also scanned all of the patients for
eGFRs ≥ 30 ml/min/1.73 m2 who were admitted adrenal adenomas during the USG.
to our internal medicine outpatient clinic between Each of the patients signed an informed con-
June 2017 and January 2018. All the patients were sent form, and the study protocol was approved
evaluated for the presence of risk factors, includ- by the local ethics committee.
ing secondary hypertension, hyperlipidaemia, dia-
betes mellitus, renal, cardiovascular and cerebro- Laboratory assessments
vascular diseases and smoking.
Upon admittance, a complete blood count, in-
cluding the leukocytes, neutrophils, lymphocytes
Blood pressure measurements and platelets, and the blood urea nitrogen, creat-
Hypertension was defined as systolic blood inine and uric acid were evaluated using venous
pressure (SBP) ≥ 140 mm Hg and/or diastolic blood blood. Diabetes mellitus was defined as fasting
pressure (DBP) ≥ 90 mm Hg, previously diagnosed plasma glucose levels more than 126 mg/dl in
hypertension, or use of any antihypertensive med- multiple measurements. Venous blood was taken
ications. The arterial BP of each patient was mea- from the patients in the morning after 8 h of fast-
sured using a standardized protocol. Each patient ing. Previously diagnosed diabetes mellitus and/
remained at rest for at least 10 min in a seated po- or use of antidiabetic medications such as oral
sition, and their arms were supported at the level anti-diabetic agents or insulin were considered to

Arch Med Sci 5, September / 20191233

Nurhayat Ozkan Sevencan, Aysegul Ertinmaz Ozkan

be DM as well. The microalbumin was evaluated were used for the paired comparisons. Pearson’s
in the spot urine collected from the patients. The correlation test was used to reveal a linear associ-
NLR was calculated from the ratio of the neutro- ation between eGFRs, albuminuria and serum uric
phil to lymphocyte counts and the PLR was calcu- acid levels. A logistic regression analysis was used
lated from the ratio of the platelet to lymphocyte to assess the risk factors affecting the eGFR. To
counts. The eGFR was calculated using the Chron- determine the cut-offs for the parameters, diag-
ic Kidney Disease Epidemiology Collaboration nostic tests (sensitivity, specificity, positive predic-
(CKD-EPI) equation [21]. The patients were divid- tive value (PPV), negative predictive value (NPV)
ed into two groups: those with an eGFR ≥ 60 ml/ and accuracy) and receiver operating characteris-
min/1.73 m2 (CKD stages 1 and 2) and those with tic (ROC) curve analyses were used. The compar-
60 > eGFR ≥ 30 ml/min/1.73 m2 (CKD stage 3). isons of the areas under the ROC curve were per-
formed using the DeLong method. The statistical
Statistical analysis significance was set at p < 0.05.
The Number Cruncher Statistical System 2007
Results
(NCSS Statistical Software, Kaysville, UT, USA) was
used for the statistical analyses. We used descrip- The present study included 185 (68.3%) fe-
tive statistical methods (mean, standard devia- males and 86 (31.7%) males, and their mean age
tion, frequency, percentage, minimum and maxi- was 63.94 ±11.19 years old. Demographic data of
mum) to assess the study data. Additionally, the the two studied groups are shown in Table I.
normality of distribution of the quantitative data The NLR, albuminuria and uric acid levels of the
was tested using the Shapiro-Wilk test and graph- patients with stage 3 CKD were higher than those
ical examinations. For the normally distributed with stages 1 and 2 (p = 0.013, p = 0.001 and p =
quantitative variables, a one-way analysis of vari- 0.001, respectively). However, no statistically sig-
ance was used for the comparison of more than nificant difference was detected for the PLR. The
two groups. Bonferroni-corrected post-hoc tests results of the laboratory tests are shown in Table II.

Table I. Demographic characteristics of the two studied groups of patients according to eGFR

Variables All patients eGFR ≥ 60 60 > eGFR ≥ 30 P-value

(n = 271) (n = 242) (n = 29)
Female, n (%) 185 (68.3) 164 (67.8) 21 (72.4) 0.612

Male, n (%) 86 (31.7) 78 (32.2) 8 (27.6)

Age, mean ± SD [years] 63.94 ±11.19 62.39 ±10.49 76.90 ±8.14 0.001c

Height, mean ± SD [cm] 161.26 ±7.67 161.35 ±7.84 160.48 ±6.22 0.566c

Weight, mean ± SD [kg] 78.55 ±13.94 79.00 ±14.01 74.76 ±12.91 0.122c

BMI, mean ± SD [kg/m2] 30.22 ±5.18 30.35 ±5.16 29.10 ±5.30 0.221c

Systolic BP, mean ± SD [mm Hg] 134.38 ±18.73 133.95 ±18.33 137.93 ±21.85 0.280c

Diastolic BP, mean ± SD [mm Hg] 83.41 ±10.16 83.07 ±10.01 86.21 ±11.15 0.116c

Smoker, n (%) 55 (20.3) 48 (19.8) 7 (24.1) 0.586a

CVD, n (%) 12 (4.4) 9 (3.7) 3 (10.3) 0.125b

CKD, n (%) 21 (7.7) 11 (4.5) 10 (34.5) 0.001b

CAD, n (%) 69 (25.5) 55 (22.7) 14 (48.3) 0.003a

CABG, n (%) 12 (4.4) 10 (4.1) 2 (6.9) 0.624b

Coronary stent, n (%) 18 (6.6) 16 (6.6) 2 (6.9) 1.000b

Use of ACE and ARB, n (%) 195 (72.2) 173 (71.5) 22 (78.6) 0.428a

Use of BB, n (%) 67 (24.8) 59 (24.4) 8 (28.6) 0.627a

Use of CCB, n (%) 77 (28.6) 64 (26.6) 13 (46.4) 0.028a

eGFR – estimated glomerular filtration rate (ml/min/1.73 m2), BMI – body mass index, BP – blood pressure, CVD – cerebrovascular disease,
CKD – chronic kidney disease, CAD – coronary artery disease, CABG – coronary artery bypass graft, ACE – angiotensin converting enzyme,
ARB – angiotensin receptor blockers, BB – β-blockers, CCB – calcium channel blockers. aPearson’s c2 test, bFisher’s exact test, cone-way
ANOVA test.

1234 Arch Med Sci 5, September / 2019

 Associations between neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, albuminuria and uric acid and the estimated glomerular
filtration rate in hypertensive patients with chronic kidney disease stages 1–3

Table II. Laboratory assessments of different measured variables in the two studied groups

Variables All patients eGFR ≥ 60 60 > eGFR ≥ 30 P-valuec

(n = 271) (n = 242) (n = 29)
Glucose, mean ± SD [mg/dl] 104.57 ±22.77 104.27 ±20.92 107.03 ±35.02 0.538

Creatinine, mean ± SD [mg/dl] 0.83 ±0.19 0.80 ±0.17 1.12 ±0.10 0.001

T. cholesterol, median (min.–max.) [mg/dl] 191 (97–395) 191 (97–395) 180 (106–264) 0.236

Triglyceride, median (min.–max.) [mg/dl] 133 (43–576) 137 (43–576) 122 (51–277) 0.102

HDL, mean ± SD [mg/dl] 45.41 ±9.19 45.33 ±8.96 46.07 ±11.08 0.684

LDL, median (min.–max.) [mg/dl] 113 (45–294) 113 (46–294) 106 (45–196) 0.668

Albuminuria, median (min.–max.) [mg/dl] 22 (3.16–2446) 20 (3.2–694) 39 (5–2446) 0.001

Uric acid, median (min.–max.) [mg/dl] 5.6 (1.3–10.8) 5.4 (1.3–10.8) 7.1 (1.3–8.9) 0.001

Leukocytes, median (min.–max.) [× 103/μl] 7.2 (3.42–13) 7.2 (3.4–13) 7.5 (4.3–12.1) 0.161

Platelets, median (min.–max.) [× 103/μl] 229.4 (94.39–454.6) 230.1 (94.4–454.6) 214.2 (104.1–352.1) 0.164

Neutrophils, median (min.–max.) [× 10 /μl] 3

4.8 (1.16–10.6) 4.1 (1.2–10.7) 4.6 (2.2–9.3) 0.103

Lymphocytes, median (min.–max.) 2.2 (1.02–5.28) 2.2 (1–5.3) 2.1 (1.1–3.5) 0.078
[× 103/μl]
NLR, median (min.–max.) 1.9 (0.49–8.53) 1.8 (0.5–8.5) 2.3 (0.9–6.4) 0.010

PLR, median (min.–max.) 105.1 (43.19–288.63) 103.4 (43.2–288.6) 109.3 (64.3–200.9) 0.773
eGFR – estimated glomerular filtration rate (ml/min/1.73 m2), HDL – high-density lipoprotein, LDL – low-density lipoprotein, NLR –
neutrophil/lymphocyte ratio, PLR – platelet/lymphocyte ratio. cOne-way analysis of variance.

There was a negative, weak (low r), but statisti- the NLR and albuminuria were very similar to each
cally significant correlation between the eGFR and other, whereas the area for uric acid was larger.
the uric acid level (r = –0.270, p < 0.001) (Figure 1). However, no statistically significant differences
There was a negative, weak (low r), but statisti- were detected between the NLR and albuminuria,
cally significant correlation between the eGFR and between the NLR and uric acid, and between albu-
the albuminuria level (r = –0.185, p= 0.002) (Fig- minuria and uric acid for the areas under the ROC
ure 2). curves. The evaluations regarding the ROC curves
The results of the diagnostic tests and ROC are depicted in Table IV and Figure 3.
curves for the stage 3 patients are shown in Table III. An evaluation of the risk factors affecting the
The areas under the ROC curves were 64.3% for eGFR, including the NLR, PLR, albuminuria and uric
the NLR, 63.4% for the albuminuria and 74.3% for acid, using a stepwise logistic regression analysis
the uric acid. The areas under the ROC curves for revealed the model to be significant, with an ex-

12 R2 linear = 0.073 2500 R2 linear = 0.034

10
2000

8
Albuminuria

1500
Uric acid

y = 7.72 – 0.02x
6
1000
4

500
2
y = 0.0271 – 0.0203x
0 0

0 25 50 75 100 125 0 25 50 75 100 125

eGFR eGFR

Figure 1. Correlation between eGFR and uric acid Figure 2. Correlation between eGFR and albumin-
in studied patients uria levels in studied patients

Arch Med Sci 5, September / 20191235

Nurhayat Ozkan Sevencan, Aysegul Ertinmaz Ozkan

Table III. Diagnostic tests and ROC curve results for CKD stage 3

Variables Importance ROC curve P-value

Cut-off Sensitivity Specificity PPV NPV Area 95% CI

NLR > 1.998 62.07 59.09 15.40 92.90 0.643 0.583–0.700 0.013

Albuminuria > 25 mg/dl 58.62 56.61 13.90 91.90 0.634 0.574–0.692 0.009

Uric acid > 6.2 mg/dl 72.41 70.66 22.80 95.50 0.743 0.687–0.794 < 0.001
NLR – neutrophil/lymphocyte ratio, PPV – positive predictive value, NPV – negative predictive value, CI – confidence interval.

Table IV. Evaluations of NLR, PLR, albuminuria and uric acid regarding areas under ROC curves

Variables Area under the curve

Area Std. error (a) P-value 95% CI

Lower Upper

NLR 0.643 0.058 0.013 0.583 0.700

PLR 0.526 0.056 0.644 0.465 0.587

Albuminuria 0.634 0.052 0.009 0.574 0.692

Uric acid 0.743 0.047 < 0.001 0.687 0.794

NLR – neutrophil/lymphocyte ratio, PLR – platelet/lymphocyte ratio, CI – confidence interval.

1.0 planatory coefficient of 89.7%. At the end of step 3,

albuminuria and uric acid were found to be signif-
icant variables in the model and independent risk
0.8 factors affecting the eGFR (p < 0.05). However, the
NLR and PLR did not affect the eGFR statistically
significantly. The results of the logistic regression
0.6 analysis of the risk factors affecting the eGFR are
Sensitivity

shown in Table V.

0.4 Discussion
The current study investigated the associations
0.2 between the NLR and PLR and the eGFR, and their
ability to serve as independent risk factors for re-
nal damage. To the best of our knowledge, this is
0 the first study in the literature to assess the po-
0 0.2 0.4 0.6 0.8 1.0 tentials of the NLR and PLR as predictors of essen-
1-Specificity tial hypertension in patients with CKD stages 1–3.
NLR PLR Albuminuria Uric acid
This study demonstrated higher NLR, albumin-
Figure 3. ROC curves for NLR, PLR, albuminuria, and uria, and uric acid levels in the patients with stage 3
uric acid
CKD than in those with stages 1 and 2. However,

Table V. Logistic regression analysis of risk factors affecting eGFR

Variables P-value OR 95% CI

Lower Upper

Albuminuria 0.042 1.002 1.000 1.004

Uric acid 0.001 1.539 1.204 1.966

NLR 0.104 1.290 0.949 1.755

PLR 0.578 0.996 0.983 1.009

NLR – neutrophil/lymphocyte ratio, PLR – platelet/lymphocyte ratio, OR – odds ratio, CI – confidence interval.

1236 Arch Med Sci 5, September / 2019

 Associations between neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, albuminuria and uric acid and the estimated glomerular
filtration rate in hypertensive patients with chronic kidney disease stages 1–3

no statistically significant difference was detected of 1.9 or more, demonstrated a high specificity in
in the PLR. In the stage 3 patients, the albumin- predicting a low eGFR (similar to albuminuria and
uria and uric acid were found to be independent uric acid). Additionally, at a cut-off of 5.8, the NLR
risk factors affecting the eGFR, but the effects of showed a specificity of more than 99%. In their
the NLR and PLR on the eGFR were not statistically study, Tatar et al. did not find a statistically sig-
significant. nificant association between the PLR and eGFR in
Derived from the leukocyte count, the NLR is patients with CKD stages 3–5 [19]. Similarly, we
an inexpensive, routinely used and reproducible did not detect a significant association between
test that has been revealed by many studies to the eGFR and PLR in patients with CKD stages 1–3.
be an indicator of the systemic inflammatory re- Both microalbuminuria and macroalbuminuria
sponse. In addition, many studies have shown it to are considered to be indicators of the progression
be associated with poor clinical outcomes in car- of renal dysfunction, and they are still in use. They
diac disease and several malignancies [8–11, 22, also serve as predictors of cardiovascular disease
23]. The NLR is a parameter that provides infor- [17, 18, 30]. Especially in the geriatric population
mation not only about the inflammation, but also with normal renal function, the detection of mi-
about the stress response of the patient. A high croalbuminuria is indicative of silent and asymp-
neutrophil count primarily reflects infection, while tomatic systemic vascular progression [18]. In ad-
a low lymphocyte count indicates poor general dition, the data in the current study demonstrated
health and physiological stress [10]. The blood that albuminuria was an independent predictor of
NLR is an indicator of the general inflammatory renal damage in patients with CKD stage 3.
condition and stress status of the body. A recent A serum uric acid elevation is a common mani-
study reported that the NLR was associated with festation of essential hypertension, and it is asso-
an increased mortality rate and poor progno- ciated with high blood pressure [15, 31, 32]. More-
sis in acute coronary syndrome, especially when over, it is a potential factor in the development
ST-segment elevation is present [11]. In light of and/or progression of end-organ damage as a re-
the above findings, the NLR may be a beneficial sult of its association with the hypertensive status
and cost-effective method to evaluate the inflam- through several direct and indirect mechanisms
matory status. Because the inflammatory param- [31–33]. One recent study proved that the serum
eters and NLR are increased in diabetic patients uric acid was an independent factor, with a direct
[24, 25], we excluded diabetic patients from our role in the development of CKD [34]. Similarly, we
study. We aimed to assess whether the NLR, an in- found that a serum uric acid level above 6.2 mg/dl
flammatory marker in non-diabetic CKD patients, showed high specificity as an independent predic-
was increased or not. tor of renal damage.
A high platelet and low lymphocyte count are The present study evaluated the independent
associated with adverse cardiovascular outcomes. predictors of eGFR in patients with CKD stage 3.
For instance, Azab et al. found that a high PLR At an NLR > 1.998, the sensitivity was 62.07% and
could serve as an indicator of long-term mor- the specificity was 59.09%; the PPV was 15.4%
tality in patients with acute coronary syndrome and the NPV was 92.9%. The areas under the ROC
without ST-segment elevation [26]. Elevated NLR curves were 64.3% for the NLR, 63.4% for albu-
or PLR levels have been demonstrated to be as- minuria and 74.3% for uric acid. The similarity of
sociated with various adverse clinicopathological the areas under the ROC curves for the NLR and
conditions in patients with certain malignancies, albuminuria is striking, although the area for the
including ovarian cancer, colorectal cancer and uric acid was higher. Moreover, albuminuria and
pancreatic ductal adenocarcinoma [22, 23, 27]. uric acid were independent risk factors affecting
Moreover, associations between the NLR and PLR the eGFR. However, the effects of the NLR and PLR
and cardiovascular disease have been demon- on the eGFR were not statistically significant.
strated in many studies [26, 28, 29]. For exam- We included all patients with essential hyper-
ple, Sunbul et al. showed them to be significantly tension who were referred to the internal medi-
higher in non-dipper hypertension patients when cine clinic of our hospital. However, the number of
compared to dipper hypertension patients. Fur- enrolled females in the present study was higher
thermore, the PLR (not NLR) has been shown to than that of males (68.3% vs. 31.7%). This may
be an independent predictor of non-dipper hy- be due to greater negligence and non-compliance
pertension [29]. Another recent study reported of males as regards seeking medical advice and
the NLR to be a predictor of all-cause mortality consumption of medication. Moreover, women
in geriatric patients with CKD stages 3–5 [19]. consider their illnesses to be more important than
Similarly, in the present study, an increased NLR men do, and they regularly follow-up with their
was observed in the patients with CKD stage 3. doctor visits more carefully than men. Further-
The NLR level, especially in patients with values more, according to our hospital statistics, women

Arch Med Sci 5, September / 20191237

Nurhayat Ozkan Sevencan, Aysegul Ertinmaz Ozkan

are 3 times more likely to be examined than men. 10. Gibson PH, Cuthbertson BH, Croal BL, et al. Usefulness
Thus, there was a gender bias in our study. In ad- of neutrophil/lymphocyte ratio as predictor of new-on-
dition, it is known that oestrogen levels provide set atrial fibrillation after coronary artery bypass graft-
ing. Am J Cardiol 2010; 105: 186-91.
protection against inflammation and cardiovas- 11. Park JJ, Jang HJ, Oh IY, et al. Prognostic value of neu-
cular diseases. While higher oestrogen levels are trophil to lymphocyte ratio in patients presenting with
associated with lower inflammation and a lower ST-elevation myocardial infarction undergoing primary
probability of ischemic stroke, cognitive functions percutaneous coronary intervention. Am J Cardiol 2013;
are also found to be better in these patients [35, 111: 636-42.
36]. This selection bias may have affected our 12. Tsiara S, Elisaf M, Jagroop IA, Mikhailidis DP. Platelets
results. We included all essential hypertensive as predictor of vascular risk: is there a practical index
of platelet activity? Clin Appl Thromb Hemost 2003; 9:
patients with eGFRs ≥ 30 ml/min/1.73 m2 in our
177-90.
study. However, angiotensin receptor blockers 13. Dohi Y. The first step aiming at the prevention of hyper-
(ARB), such as losartan, which protects patients tension and atherosclerosis. Identification of individu-
against nephropathy, could have been listed in the als at high risk of hypertension. Rinsho Byori 2015; 63:
exclusion criteria. 1303-9.
In conclusion, the NLR and PLR were not inde- 14. Biyik I, Uzun F, Erturk M, et al. Does contrast media vol-
pendent predictors of the eGFR and renal damage ume affect long-term survival in patients with chronic
kidney disease? Arch Med Sci Atheroscler Dis 2017; 9:
(in CKD patients who do not require renal replace-
e82-9.
ment therapy). Based on the current data, future 15. Borghi C, Rosei EA, Bardin T, et al. Serum uric acid and
studies including more patients and different pop- the risk of cardiovascular and renal disease. J Hypertens
ulations are warranted to evaluate the applicabili- 2015; 33: 1729-41.
ty of this NLR model. 16. Maloberti A, Maggioni S, Occhi L, et al. Sex-related re-
lationships between uric acid and target organ dam-
Conflict of interest age in hypertension. J Clin Hypertens 2017; 20: 193-200.
17. Gerstein HC, Mann JF, Yi Q, et al. Albuminuria and risk of
The authors declare no conflict of interest. cardiovascular events, death and heart failure in diabet-
ic and nondiabetic individuals. JAMA 2001; 286: 421-6.
18. Xiang Lei K, Xiao Yan J, Yong W, et al. Association be-
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