The relationship of neutrophil lymphocyte ratio and quality of life, anxiety depression in patients with chronic renal failure

Introduction and Aim: In our study, the association between neutrophil - lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), different stages of Chronic Kidney Disease, quality of life, anxiety and depression were investigated in chronic kidney disease (CKD) patients. Materials and Methods: 125 patients with CKD who applied to Manisa Celal Bayar University Hospital Nephrology Outpatient Clinic were included in the study. Short Form-36 (SF–36) and Hospital Anxiety and Depression Scale (HAD) were administered to the patients during their controls. Simultaneously, the complete blood counts of the patients were recorded. NLR was calculated by dividing the absolute neutrophil count to the absolute lymphocyte count. The relationship between NLR with different stages of Chronic Kidney Disease, quality of life, anxiety and depression scales was compared. Results: According to the HAD Scale, 39.2% of the patients had depression and 17.6% had anxiety. NLR was found to be higher in patients with anxiety (r=+0.374, p<0.001) and/or depression (r=+0.566, p<0.001). PLR was found to be higher in patients with anxiety (r=+0.273, p=0.002) and/or depression (r=+0.400, p<0.001). A statistically negative correlation was found between NLR and quality of life. (p<0.001) A statistically negative correlation was found between PLR and quality of life. (p<0.001) NLR was statistically more significant than PLR in predicting quality of life, anxiety and depression in different stages of Chronic Kidney Disease. A statistically negative correlation was found between GFR (Glomerular Filtration Rate) with the frequency of depression and anxiety (r=-0,561, p<0,001, r=-0,443, p<0,001 respectively), NLR ( r=-0,693,p<0,001) and PLR (r=-0,504, p<0,001). A statistically positive correlation was found between GFR and quality of life. (p<0,001). A statistically positive correlation was found between anxiety score and depression score. (r=+0.657, p<0.001). It was observed that the quality of life decreased with the increase in anxiety and/or depression scores (p<0.001). The two groups with/without dialysis were compared; it was observed that the frequency of depression (r=+0.219, p=0.014), NLR (r=+0.370, p<0.001) and PLR (r = +0.240, p=0.007) was higher in the dialysis group. It was observed that statistically positive correlation was found between education level and GFR (r=+0.308, p<0.001). It was observed that statistically negative correlation was found between education level with NLR (r=-0.247, p=0.005) and the frequency of depression (r=-0.244, p=0.006). It was observed that the quality of life increased in patients with higher education levels. (p=0,001). It was observed that the quality of life decreased in those with HT (hypertension). It was observed that NLR (r=+0.297, p=0.001), PLR (r=+0.245, p=0.006), the frequency of depression (r=+0,246, p=0,006), and the frequency of anxiety (r=+0.265, p=0.003) increased in those with HT. Conclusion: In our study, as the NLR, which is a marker of low-grade inflammation, increases, quality of life and GFR decrease, while anxiety and depression increase in CKD patients. NLR was statistically more significant than PLR in predicting quality of life, anxiety and depression. When we scan the literature; we didn't find any similar studies showing the association between different stages of CKD, NLR, PLR, quality of life, anxiety and depression. Our study has the feature of being the first in this field. Our study will lead to multicenter studies that will be executed with more patients Key words: Chronic Kidney Disease (CKD), Neutrophil/Lymphocyte Ratio (NLR), Platelet-Lymphocyte Ratio (PLR), Quality of Life, Anxiety, Depression, HAD, SF–36