Neutrophil-Lymphocyte Ratio as Predictor of Mortality in Regular Hemodialysis Patients at Tabanan General Hospital


  • Manik Parmelia Tabanan Regional General Hospital
  • I Nyoman Sutarka Tabanan Regional General Hospital



neutrophil lymphocyte ratio, inflammation, mortality, chronic kidney disease, hemodialysis


The risk of mortality in chronic kidney disease (CKD) patients is higher than in normal population. Inflammation has an important role in the high mortality in CKD patients undergoing hemodialysis (HD). The neutrophil lymphocyte ratio (NLR) is a simple parameter and has been widely associated with poor outcomes in HD patients but has not been widely implemented in Indonesia, especially in Bali. This research prospectively analyzed survival of 186 patients aged 18-90 years undergoing regular HD 2x/week for at least 3 months. NLR was calculated by dividing the absolute number of neutrophils and lymphocytes. The Survival test was performed by the Kaplan-Meier method and compared with the log-rank test. Univariate and multivariate tests were performed to assess the prognostic impact of NLR and other clinical factors on all-cause mortality in HD patients. Mortality was found higher in the group with high NLR values (p-value 0.003). High NLR was significantly associated with all-cause mortality (HR 3.206; 95% CI 1.467 – 7.004; p value 0.003) and remained an independent factor on mortality in routine HD patients after adjustment to other variables (aHR 2.696, 95% CI 1.176 – 6.182, p-value: 0.019). In conclusion, High NLR is independently associated with all-cause mortality in CKD patients undergoing regular HD. NLR can be used as an inflammation marker that is considered easy and affordable and can be used to help determine populations that require special attention in order to reduce the mortality of patients with HD.

Author Biographies

Manik Parmelia, Tabanan Regional General Hospital

General Practitioner, Intern in Internal Medicine Departement, Tabanan Regional General Hospital, Bali, Indonesia

I Nyoman Sutarka, Tabanan Regional General Hospital

Nephrologist, Internal Medicine Department, Tabanan Regional General Hospital, Bali, Indonesia


Adejumo, O. A., Okaka, E. I., & Ojogwu, L. I. (2016). Lipid profile in pre-dialysis chronic kidney disease patients in southern Nigeria. Ghana Medical Journal, 50(1), 44–49.

Dheda, S., Vesey, D. A., Hawley, C., Johnson, D. W., & Fahim, M. (2022). Effect of a Hemodialysis Session on Markers of Inflammation and Endotoxin. International Journal of Inflammation, 2022(ii).

Ebert, T., Neytchev, O., Witasp, A., Kublickiene, K., Stenvinkel, P., & Shiels, P. G. (2021). Inflammation and Oxidative Stress in Chronic Kidney Disease and Dialysis Patients. Antioxidants & Redox Signaling, 35(17), 1426–1448.

Ebert, T., Pawelzik, S.-C., Witasp, A., Arefin, S., Hobson, S., Kublickiene, K., Shiels, P. G., Bäck, M., & Stenvinkel, P. (2020). Inflammation and Premature Ageing in Chronic Kidney Disease. Toxins, 12(4), 227.

GBD 2013 Mortality and Causes of Death Collaborators. (2015). Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 385(9963), 117–171.

Imtiaz, F., Shafique, K., Saeed Mirza, S., Ayoob, Z., Vart, P., & Rao, S. (2012). Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. International Archives of Medicine, 5, 2.

Kamińska, J., Stopiński, M., Mucha, K., Jędrzejczak, A., Gołębiowski, M., Niewczas, M. A., Pączek, L., & Foroncewicz, B. (2019). IL 6 but not TNF is linked to coronary artery calcification in patients with chronic kidney disease. Cytokine, 120, 9–14.

Kovesdy, C. P. (2022). Epidemiology of chronic kidney disease: an update 2022. Kidney International Supplements, 12(1), 7–11.

Li, H., Lu, X., Xiong, R., & Wang, S. (2017). High Neutrophil-to-L ymphocyte Ratio Predicts Cardiovascular Mortality in Chronic Hemodialysis Patients. Mediators of Inflammation, 2017(Lvmi).

Neuen, B. L., Leather , N., Greenwood, A. M., Gunnarsson, R., Cho, Y., & Mantha, M. L. (2016). Neutrophil-lymphocyte ratio predicts cardiovascular and all-cause mortality in hemodialysis patients. Renal Failure, 38(1), 70–76.

Ningrum, N. S., Rudiansyah, M., Pratiwi, D. I. N., Zaitun, N., & Hendriyono, F. X. (2023). Korelasi Lama Hemodialisis Dan Kadar C-Reactive Protein (Crp) Pada Pasien Hemodialisis Rutin. Homeostasis, 5(3), 562.

Nowak, K. L., & Chonchol, M. (2018). Does inflammation affect outcomes in dialysis patients? Seminars in Dialysis, 31(4), 388–397.

Perkumpulan Nefrologi Indonesia. (2018). 11th report of Indonesian renal registry 2018. In Indonesian Renal Registry (IRR).

Sameiro-Faria, M. Do, Ribeiro, S., Costa, E., Mendonça, D., Teixeira, L., Rocha-Pereira, P., Fernandes, J., Nascimento, H., Kohlova, M., Reis, F., Amado, L., Bronze-Da-Rocha, E., Miranda, V., Quintanilha, A., Belo, L., & Santos-Silva, A. (2013). Risk factors for mortality in hemodialysis patients: Two-year follow-up study. Disease Markers, 35(6), 791–798.

United States Renal Data System. (2022). 2022 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. https://usrds- disease/6-mortality.

Xiang, F., Chen, R., Cao, X., Shen, B., Liu, Z., Tan, X., Ding, X., & Zou, J. (2018). Monocyte/lymphocyte ratio as a better predictor of cardiovascular and all-cause mortality in hemodialysis patients: A prospective cohort study. Hemodialysis International, 22(1), 82–92.




How to Cite

Parmelia, M., & Sutarka, I. N. (2023). Neutrophil-Lymphocyte Ratio as Predictor of Mortality in Regular Hemodialysis Patients at Tabanan General Hospital. Jurnal Kedokteran, 12(2), 150–156.