Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio, and Systemic Immune-Inflammation Index Association With Nutritional Markers in Maintenance Hemodialysis Patients Publisher



Alirezaei T ; Esmailsorkh F ; Assadiasl S ; Aghabagheri M ; Dalili N ; Amini H ; Freidoon M
Source: Journal of Iranian Medical Council Published:2026

Abstract

Background: Cardiovascular Disease (CVD) is the leading cause of death in patients with End-Stage Renal Disease (ESRD) undergoing Hemodialysis (HD). Recent studies have demonstrated that the Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Systemic Immune-Inflammation Index (SII) may help identify individuals at high risk of CVD. Malnutrition and inflammation have also been identified as significant risk factors for CVD in HD patients. Methods: Eighty-nine patients undergoing maintenance hemodialysis were included in the study. Nutritional parameters—including albumin, uric acid, Blood Urea Nitrogen (BUN), creatinine, triglycerides, cholesterol, Low-Density Lipoprotein (LDL), High-Density Lipo-protein (HDL), Fasting Blood Sugar (FBS), and Hemoglobin A1c (HbA1c)—were measured. The relationship between these parameters and NLR, PLR, and SII, was analyzed. Results: BUN, creatinine, uric acid, ferritin, FBS, HbA1c, LDL, and triglycerides were positively correlated with PLR, NLR, and SII (p<0.05). Conversely, albumin was negatively correlated with NLR and SII; as albumin levels increased, NLR and SII decreased (p<0.05). The correlation between albumin and PLR was not statistically significant (p>0.05). HDL was significantly negatively associated with NLR, PLR, and SII. Additionally, age had a significant effect on the variation of SII, NLR, and PLR (p<0.05). Conclusion: The three novel inflammatory composite indices—SII, NLR, and PLR—were closely associated with common nutritional biomarkers and may serve as cost-effective and convenient markers for predicting clinical prognosis in ESRD patients with CVD risk. © 2026, Journal of Iranian Medical Council.