Neutrophil to Lymphocyte Ratio is a Better Tool than Monocyte to HDL-C Ratio and Neutrophil to HDL-C Ratio in Type 2 Diabetic Kidney Disease

Abstract

Abstract Background Type 2 diabetes mellitus (T2DM) patients are likely to develop kidney disease. Early diagnosis, finding predictors and controlling risk factors are of great significance for T2DM patients. Chronic inflammation plays an important role in the occurrence and development of diabetic kidney disease (DKD). This study investigated the relationship among the new inflammatory markers, namely, the neutrophil to lymphocyte ratio (NLR), monocyte to high-density lipoprotein ratio (MHR) and neutrophil to high-density lipoprotein ratio (NHR), and type 2 diabetic kidney disease (T2DKD) and evaluated which is more valuable in the inflammatory process of DKD. Methods A total of 1142 adult T2DM patients were enrolled in the current study. Patients were stratified into three groups according to their albumin excretion rate (AER). Spearman correlation was used to analyze the correlations between the AER, eGFR and clinical variables. Logistic regression analysis was used to assess the associations among the three new inflammatory markers and DKD in patients with T2DM. Receiver operating characteristic (ROC) analyses and the area under the ROC curve (AUC) were then used to assess the ability of the NLR, MHR, and NHR to discriminate DKD, macroalbuminuria and kidney impairment in T2DM patients. Results The AER was significantly positively correlated with the NLR, MHR and NHR, while eGFR was significantly negatively correlated with the NLR, MHR and NHR (P < 0.05 for all). The NLR, MHR and NHR all demonstrated strong positive associations with DKD risk in T2DM patients in the crude model and after adjusting for confounding factors (P < 0.05 for all). The NLR had the highest AUC among the three indicators for DKD, macroalbuminuria and kidney impairment in T2DM patients. The NLR, MHR and NHR all had significant discriminative ability for macroalbuminuria in patients with T2DM. Conclusions The NLR, MHR and NHR were all risk factors for type 2 diabetes nephropathy. The NLR was a better predictor of DKD, macroalbuminuria and kidney impairment (eGFR < 60 mL/min/1.73 m2) than the MHR and NHR.