Case Control Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2024; 12(14): 2308-2315
Published online May 16, 2024. doi: 10.12998/wjcc.v12.i14.2308
Neutrophil-to-lymphocyte ratio associated with renal function in type 2 diabetic patients
Jin-Li Gao, Jue Shen, Li-Ping Yang, Li Liu, Kai Zhao, Xiao-Rong Pan, Lei Li, Ji-Ji Xu
Jin-Li Gao, Department of Prevention and Health Care, Community Health Service Center of Miaohang Town, Shanghai 200443, China
Jue Shen, Li-Ping Yang, Department of Prevention and Health Care, Community Health Service Center of Songnan Town, Shanghai 200434, China
Li Liu, Kai Zhao, Xiao-Rong Pan, Ji-Ji Xu, Department of General Practice, Community Health Service Center of Songnan Town, Shanghai 200434, China
Lei Li, Department of Administrative, Community Health Service Center of Songnan Town, Shanghai 200434, China
Co-first authors: Jin-Li Gao and Jue Shen.
Co-corresponding authors: Lei Li and Ji-Ji Xu.
Author contributions: Gao JL conceived, designed, and refined the study protocol; Zhao K, Pan XR, Yang LP, and Liu L were involved in the data collection; Xu JJ and Li L analyzed the data; Gao JL and Shen J drafted the manuscript; Xu JJ and Li L revised the manuscript; all authors were involved in the critical review of the results and have contributed to, read, and approved the final manuscript. Gao JL and Shen J contributed equally to this work as co-first authors; Xu JJ and Li L contributed equally to this work as co-corresponding authors. There are three reasons for designating Xu JJ and Li L as co-corresponding authors. First, this study was a collaborative effort and both Xu JJ and Li L made equally important contributions throughout the course of the study. The designation of co-corresponding authors accurately reflects the distribution of responsibilities and burdens in terms of time and effort required to complete this study and the paper, and also recognizes and respects their equal contributions. Second, Xu JJ and Li L made great efforts to obtain research funding, which was a key factor in making the research possible. Finally, the fact that the whole research team consisted of authors from different fields with different expertise and skills also contributed to the most comprehensive and in-depth exploration of the research topic, which ultimately enriched the readers' understanding by providing different expert perspectives. In conclusion, we believe that the designation of Xu JJ and Li L as co-corresponding authors is highly appropriate, as it accurately reflects the collaborative spirit, equal contribution and diversity of our team.
Supported by Health Commission of Baoshan District, Shanghai, China, No. BSJCPP-A-04 and No. BSZK-2023-T04; and the Science and Technology Commission of Baoshan District, Shanghai, China, No. 20-E-63 and No. 21-E-34.
Institutional review board statement: This study was approved by the Ethics Committee of Community Health Service Center of Songnan Town, Baoshan District, Shanghai, China.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at 13916799696@139.com.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ji-Ji Xu, MBBS, Deputy Director, Department of General Practice, Community Health Service Center of Songnan Town, No. 301 Songliang Road, Baoshan District, Shanghai 200434, China. 13916799696@139.com
Received: December 28, 2023
Revised: February 14, 2024
Accepted: April 2, 2024
Published online: May 16, 2024
Processing time: 128 Days and 19.9 Hours
Abstract
BACKGROUND

Type 2 diabetes mellitus (T2DM) is a leading risk factor for the development and progression of chronic kidney disease (CKD). However, an accurate and convenient marker for early detection and appropriate management of CKD in individuals with T2DM is limited. Recent studies have demonstrated a strong correlation between the neutrophil-to-lymphocyte ratio (NLR) and CKD. Nonetheless, the predictive value of NLR for renal damage in type 2 diabetic patients remains understudied.

AIM

To investigate the relationship between NLR and renal function in T2DM patients.

METHODS

This study included 1040 adults aged 65 or older with T2DM from Shanghai's Community Health Service Center. The total number of neutrophils and lymphocytes was detected, and NLR levels were calculated. CKD was defined as an estimated glomerular filtration rate ≤ 60 mL/min/1.73 m². Participants were divided into four groups based on NLR levels. The clinical data and biochemical characteristics were compared among groups. A multivariate logistic regression model was used to analyze the association between NLR levels and CKD.

RESULTS

Significant differences were found in terms of sex, serum creatinine, blood urea nitrogen, total cholesterol, and low-density lipoprotein cholesterol among patients with T2DM in different NLR groups (P < 0.0007). T2DM patients in the highest NLR quartile had a higher prevalence of CKD (P for trend = 0.0011). Multivariate logistic regression analysis indicated that a high NLR was an independent risk factor for CKD in T2DM patients even after adjustment for important clinical and pathological parameters (P = 0.0001, odds ratio = 1.41, 95% confidence intervals: 1.18-1.68).

CONCLUSION

An elevated NLR in patients with T2DM is associated with higher prevalence of CKD, suggesting that it could be a marker for the detection and evaluation of diabetic kidney disease.

Keywords: Type 2 diabetes mellitus; Neutrophil-to-lymphocyte ratio; Chronic kidney disease; Logistic regression; Diabetes mellitus

Core Tip: In elderly type 2 diabetes mellitus (T2DM) patients, elevated neutrophil-to-lymphocyte ratio (NLR) is strongly linked to an increased risk of chronic kidney disease (CKD), uncovering NLR as a potential independent biomarker for early detection of renal damage. This finding holds significant promise for addressing the current challenge of delayed CKD diagnosis in T2DM, signifying the potential utility of NLR as a convenient and sensitive detection method for identifying CKD in diabetic patients.