NEUTROPHIL TO LYMPHOCYTE RATIO AS A PREDICTOR OF PERIPHERAL ARTERIAL DISEASES AMONG REGULAR HEMODIALYSIS PATIENTS

Document Type : Original Article

Authors

1 Departments of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

2 Department of Diagnostic Radiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Abstract

Background: Peripheral arterial disease (PAD) is common in patients with end-stage renal disease on regular hemodialysis. Neutrophil to lymphocyte ratio (NLR) is considered an indicator of the severity and extent of systemic inflammation and atherosclerosis in patients with renal and cardiovascular disorders.
Objective: To assess neutrophil to lymphocyte ratio as a predictor of peripheral arterial diseases in regular hemodialysis patients.
Patients and Methods: This cross-sectional study was carried out at Hemodialysis Unit of Al-Hussein University Hospital over a period of six months from January to July 2020, and conducted on 40 hemodialysis patients. Demographic data and clinical information were recorded. Laboratory data including CBC, calcium, phosphate, albumin, cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, iron profile were evaluated. The ankle-brachial index was measured in all patients. PAD was diagnosed if ankle-brachial index (ABI) ≤ 0.9. Duplex ultrasound for arterial system of both lower limbs was done for patient with ankle-brachial index≤ 0.9.
Results: There were 29 males (72.5%) and 11 females (27.5%). The mean age of all patients was 43.2 ± 10.3 years. There were 7 diabetic (17.5%) patients, and 27 hypertensive (67.5%) patients. Regarding CBC, the mean of white blood cells (WBCs), neutrophils, lymphocytes, NLR, hemoglobin (Hb) and platelets (PLT) were 6.5 ± 1.7 (x10³/ul), 4.3 ± 1.5 (x10³/ul), 1.74 ± 0.53 (x10³/ul), 2.73 ± 1.3, 10.8 ± 2.3 (g/dl), and 234.7 ± 95.9 (x10³/ul) respectively. Regarding lipid profile, the mean of total cholesterol, high density lipoprotein (HDL) and triglycerides were 214.7 mg/dL, 41.9 mg/dL, 172.2 mg/dL, respectively. Regarding serum albumin, corrected serum calcium (Ca), serum phosphorus (PO4), serum Ca X PO4 product, and parathyroid hormone (PTH), the means were 3.99 ± 0.5 (g/dl), 8.3 ± 0.6 (mg/dl), 5.22 ± 1.1 mg/dl, 43.7 ± 11.2 and 722.1 ± 477.7 (ug/ml) respectively. Regarding to ABI, there were 13 patients (32.5%) ≤ 0.9, while there were 27 patients (67.5%) > 0.9.
Conclusion: Neutrophil-lymphocyte ratio (NLR) could be considered as a predictor of peripheral arterial diseases (PADs) among regular haemodialysis patients.

Keywords

Main Subjects


NEUTROPHIL TO LYMPHOCYTE RATIO AS A PREDICTOR OF PERIPHERAL ARTERIAL DISEASES AMONG REGULAR HEMODIALYSIS PATIENTS

By

 

Amr Abd El-Khaleq El-Hashash*, Safwat Farrag*, Hazem Ayoub * and Mohamed El-Feshawy**

*Departments of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

**Department of Diagnostic Radiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Corresponding author: Amr Abd El-Khaleq El-Hashash

Mobile: 01098835347, E-mail: aaelhashash@gmail.com

ABSTRACT

Background: Peripheral arterial disease (PAD) is common in patients with end-stage renal disease on regular hemodialysis. Neutrophil to lymphocyte ratio (NLR) is considered an indicator of the severity and extent of systemic inflammation and atherosclerosis in patients with renal and cardiovascular disorders.

Objective: To assess neutrophil to lymphocyte ratio as a predictor of peripheral arterial diseases in regular hemodialysis patients.

Patients and Methods: This cross-sectional study was carried out at Hemodialysis Unit of Al-Hussein University Hospital over a period of six months from January to July 2020, and conducted on 40 hemodialysis patients. Demographic data and clinical information were recorded. Laboratory data including CBC, calcium, phosphate, albumin, cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, iron profile were evaluated. The ankle-brachial index was measured in all patients. PAD was diagnosed if ankle-brachial index (ABI) ≤ 0.9. Duplex ultrasound for arterial system of both lower limbs was done for patient with ankle-brachial index≤ 0.9.

Results: There were 29 males (72.5%) and 11 females (27.5%). The mean age of all patients was 43.2 ± 10.3 years. There were 7 diabetic (17.5%) patients, and 27 hypertensive (67.5%) patients. Regarding CBC, the mean of white blood cells (WBCs), neutrophils, lymphocytes, NLR, hemoglobin (Hb) and platelets (PLT) were 6.5 ± 1.7 (x10³/ul), 4.3 ± 1.5 (x10³/ul), 1.74 ± 0.53 (x10³/ul), 2.73 ± 1.3, 10.8 ± 2.3 (g/dl), and 234.7 ± 95.9 (x10³/ul) respectively. Regarding lipid profile, the mean of total cholesterol, high density lipoprotein (HDL) and triglycerides were 214.7 mg/dL, 41.9 mg/dL, 172.2 mg/dL, respectively. Regarding serum albumin, corrected serum calcium (Ca), serum phosphorus (PO4), serum Ca X PO4 product, and parathyroid hormone (PTH), the means were 3.99 ± 0.5 (g/dl), 8.3 ± 0.6 (mg/dl), 5.22 ± 1.1 mg/dl, 43.7 ± 11.2 and 722.1 ± 477.7 (ug/ml) respectively. Regarding to ABI, there were 13 patients (32.5%) ≤ 0.9, while there were 27 patients (67.5%) > 0.9.

Conclusion: Neutrophil-lymphocyte ratio (NLR) could be considered as a predictor of peripheral arterial diseases (PADs) among regular haemodialysis patients.

Key words: Peripheral Arterial Disease among Hemodialysis Patients, Ankle Brachial Index, The Neutrophil-Lymphocyte Ratio.

 

INTRODUCTION

     The NLR has been widely studied as marker of inflammation (Kim et al., 2019). Peripheral blood NLR is widely reported to be associated with inflammatory response and reflect the inflammatory status of many diseases (Liu et al., 2019). Patients with chronic kidney disease (CKD) are closely associated with all-cause mortality and poor prognoses of cardiovascular disorders (Valga et al., 2019). Ouellet et al. (2016) found that NLR was associated with all-cause mortality in hemodialysis (HD) patients. NLR measurements were shown to correlate well with vascular calcification in end stage renal disease (ESRD) population (Turkmen et al., 2014). PADs include all arterial diseases including carotid artery disease, mesenteric artery disease, renal artery disease and lower extremity artery disease (LEAD), and other than coronary arteries and the aorta (Aboyans et al., 2018). CKD itself is strongly and independently associated with PAD. In both the general population and patients with CKD, the risk of PAD increases as GFR values decrease (Chen et al., 2012).

     The present work aimed to study the neutrophil to lymphocyte ratio (NLR) as a predictor of peripheral arterial disease in patients maintained on regular hemodialysis.

PATIENTS AND METHODS

     This cross sectional study included 40 hemodialysis patients which were conducted at the Nephrology Unit, at Al Hussein University Hospital from January to July 2020. Written informed consent obtained from every patient for all procedures that performed. All procedures followed Al-Azhar University Ethical Committee Regulation. All patients were receiving 3 hemodialysis sessions weekly.

Inclusion Criteria:

1.   Patient`s age between 18 and 60 years and then Sub grouped into two groups above and below 40 years.

2.   Duration of hemodialysis more than 6 months.

3.   Uses of native arteriovenous fistula in all patients.

Exclusion Criteria:

1.   Patients less than 18 years or more 60 years

2.   Duration of hemodialysis less than 6 months

3.   Uncontrolled hypertension or diabetes mellitus.

4.   Recent inflammation.

5.   Known to be collagen disease.

     Diagnosis of PAD based on ankle/ brachial index.

All Patients in this study had been subjected to the following:

1.   History and clinical examination stressing on ischemic symptoms.

2.   Laboratory Investigations (Serum Creatinine – Calcium – phosphorus – intact parathyroid hormone – serum iron – serum ferritin – transferrin saturation - lipid profile(cholesterol-triglycerides-LDL-HDL).

3.   Ankle/ brachial index were measured by Doppler ultrasound.

4.   Duplex ultrasound for arterial system of both lower limb for patient with ankle-brachial index>0.9.

     Statistical analysis of data was done by using Statistical Package for the Social Sciences (SPSS) version 24.  Quantitative data were expressed as mean± standard deviation (SD). Qualitative data were expressed as frequency and percentage. Independent-samples t-test of significance or Mann Whitney U test was used when comparing between two means. Chi-square test was used when comparing between non-parametric data. Probability (P-value): P-value < 0.05 was considered significant.


 

RESULTS

 

 

     The mean age of all studied patients was 45.3 ± 8.8 years with a minimum age of 24 years and a maximum age of 62 years. There were 43 males (53.8%) and 37 females (46.3%), 35 patients (43.7%) were diabetic and 48 patients (60%) were hypertensive (Table 1).


 


Table (1):    Demographic data of studied patients

Variables

Age criteria of the studied patients

(N = 40)

Age (years)

Mean ±SD

43.2 ± 10.3

Min – Max

24 – 59

Sex

Male

29

72.5%

Female

11

27.5%

DM

No

33

82.5%

Yes

7

17.5%

HTN

No

13

32.5%

Yes

27

67.5%

 

 

     According to laboratory profile, the mean of WBCs, neutrophils, lymphocytes, NLR, Hb and platelets were 6.5 ± 1.7 (x10³/ul), 4.3 ± 1.5 (x10³/ul), 1.74 ± 0.53 (x10³/ul), 2.73 ± 1.3, 10.8 ± 2.3 (g/dl) and 234.7 ± 95.9 (x10³/ul) respectively. Regarding lipid profile, the mean of total cholesterol, HDL and triglycerides were 214.7 mg/dL, 41.9 mg/dL, 172.2 mg/dL, respectively. Regarding corrected serum Ca, serum PO4, serum Ca X PO4 product, and PTH the mean were 3.99 ± 0.5 (g/dl), 8.3 ± 0.6 (mg/dl), 5.22 ± 1.1 mg/dl, 43.7 ± 11.2 and 722.1 ± 477.7 (ug/ml) respectively (Table 2).

 

 

 

 

 

 

 

 

 

 

Table (2):    laboratory profiles in studied patients

Variables

Studied patients

(N = 40)

Normal level

white blood cells (x10³/ul)

Mean ±SD

6.5 ± 1.7

 

Min – Max

2.9 – 10.8

4-11

Neutrophil (x10³/ul)

Mean ±SD

4.3 ± 1.5

 

Min – Max

1.3 – 8.6

3-7

Lymphocytes (x10³/ul)

Mean ±SD

1.74 ± 0.53

1.5-3.5

Min – Max

0.7 – 3

 

NLR

Mean ±SD

2.73 ± 1.3

 

Min – Max

0.72 – 7

.78-3.53

hemoglobin (g/dl)

Mean ±SD

10.8 ± 2.3

Target is 11-12

Min – Max

6 – 15.9

 

Platelets (x10³/ul)

Mean ±SD

234.7 ± 95.9

150-400

Min – Max

94 – 644

 

T. cholesterol (mg/dl)

Mean ±SD

197.4 ± 26.7

 

Min – Max

154 – 260

<200

Triglycerides (mg/dl)

Mean ±SD

153.1 ± 24.01

<150

Min – Max

123 – 254

 

Low density lipoprotein (mg/dl)

Mean ±SD

144.4 ± 17.2

<100

Min – Max

119 – 188

 

High density lipoprotein (mg/dl)

Mean ±SD

41.8 ± 6.3

>40

Min – Max

30 – 56

 

Corrected calcium (mg/dl)

Mean ±SD

8.3 ± 0.6

 

Min – Max

7.4 – 9.6

8.5-10.5

Phosphorus (mg/ml)

Mean ±SD

5.22 ± 1.1

2.4-5.1

Min – Max

3.5 – 7.2

 

Ca X PO4

Mean ±SD

43.7 ± 11.2

 

Min – Max

26.6 – 64.6

<55

Parathyroid hormone (ug/ml)

Mean ±SD

722.1 ± 477.7

14-72

Min – Max

168 – 2000

 

 

 

     Regarding to ABI, there were 13 patients (32.5%) ≤ 0.9, while there were 27 patients (67.5%) > 0.9 (Table 3).

 

Table (3):    Ankle brachial index in all studied patients.

Ankle brachial index

Studied Patients (N=80)

Index ≤ 0.9

Index > 0.9

Number of Positive and Negative patients (%)

13 (32.5%)

27 (67.5%)

Mean ±SD

0.85 ± 0.06

1.13 ± 0.09

Min – Max

0.7 – 0.9

1 – 1.3

 

 

     There were statistically significant (p-value < 0.05) relationships between ankle brachial index ≤ 0.9 and (age, diabetes), and no statistically significant relation (p-value > 0.05) between ankle brachial index and sex & HTN (Table 4).

 

 

 

 

Table (4):    Relationship between results of Ankle brachial index and demographic data

Ankle brachial index

Parameters

≤ 0.9 (n = 13)

> 0.9 (n = 27)

P-value

Age (years)

Mean

48.5

40.7

0.023

±SD

7.4

10.6

Sex

Male

12

92.3%

17

63%

0.052

Female

1

7.7%

10

37%

DM

No

8

61.5%

25

92.6%

0.015

Yes

5

38.5%

2

7.4%

HTN

No

2

15.4%

11

40.7%

0.109

Yes

11

84.6%

16

59.3%

±SD

4.1

2.9

 

 

     There were high statistically significant (p-value < 0.001) relationships between ankle brachial index ≤ 0.9 and NLR, total cholesterol, LDL, PO4 and Ca X PO4 product, and statistically significant (p-value < 0.05) relationships between ankle brachial index ≤ 0.9 and Hb, TG, lower HDL and corrected Ca. No statistically significant (p-value > 0.05) relationships between ankle brachial index and WBCs& PLTs (Table 5).

 

 

Table (5):    Relationship between Ankle brachial index and laboratory results

Ankle brachial index

Parameters

≤ 0.9 (n = 13)

> 0.9 (n = 27)

P-value

White blood cells (x10³/ul)

Mean

7.3

6.2

0.056

±SD

1.7

1.6

NLR

Mean

4.0

2.1

< 0.001

±SD

1.4

0.7

Hemoglobin (g/dl)

Mean

11.8

10.3

0.044

±SD

2.3

2.1

Platelets (x10³/ul)

Mean

252.8

225.9

0.413

±SD

128.6

76.9

T. Cholesterol (mg/dl)

Mean

226.8

183.3

< 0.001

±SD

21.1

14.9

Triglycerides (mg/dl)

Mean

169.2

145.3

0.002

±SD

31.8

14.4

Low density lipoprotein (mg/dl)

Mean

160.2

136.8

< 0.001

±SD

15.2

12.5

High density lipoprotein (mg/dl)

Mean

38.1

43.5

0.009

±SD

6.2

5.6

Corrected calcium (mg/dl)

Mean

8.7

8.1

0.001

±SD

0.5

0.5

Phosphorus (mg/ml)

Mean

6.5

4.6

< 0.001

±SD

0.6

0.7

Ca X PO4

Mean

56.2

37.7

< 0.001

±SD

6.8

7.2

Parathyroid hormone (ug/ml)

Mean

1050.8

563.9

0.002

±SD

541.5

356.2

 

 

DISCUSSION

     This study was carried out at Al- Hussein University Hospital, hemodialysis unit over a period of six months from January 2020 to July 2020, and conducted on 40 hemodialysis patients. There were 72.5% males and 27.5% females. Other comorbidities were in some patients, 17.5% were diabetic and 67.5% were hypertensive. Regarding pretreatment laboratory profile, results showed that the mean WBCs, and NLR was (6.5 ± 1.7 (x10³/ul)), (4.3 ± 1.5 (x10³/ul)), (1.74 ± 0.53 (x10³/ul)), and (2.73 ± 1.3) respectively. Regarding lipid profile, the mean cholesterol, TG, LDL, and HDL was (197.4 ± 26.7 (mg/dl)), (153.1 ± 24.01 mg/dl), (144.4 ± 17.2 (mg/dl)), and (41.8 ± 6.3 (mg/dl)) respectively. Regarding results of serum Ca, PO4, Ca X PO4 product and PTH the mean was (8.3 ± 0.6 (mg/dl)), (5.22 ± 1.1 mg/dl), (43.7 ± 11.2) and (722.1 ± 477.7 (ug/ml)). The results of current study showed a high statistically significant (p-value < 0.001) correlation between ankle brachial index ≤ 0.9 and NLR, total cholesterol, LDL, Ca X PO4 product, and PO4. Furthermore, statistically significant (p-value < 0.05) correlation between ankle brachial index ≤ 0.9 and TG, corrected Ca, and PTH. There was inversely significant (p-value < 0.05) correlation between ankle brachial index ≤ 0.9 and HDL. Arroyo et al. (2017) observed in his large multicenter cohort study that the mean age of the CKD population was 57.9 6 12.8 years, and 61.7% were male patients. Prevalence of hypertension, dyslipidemia and diabetes were 89.3, 64.9 and 25.7%, respectively. CKD patients had a higher prevalence of subclinical PAD than non-CKD controls (28.0% versus 12.3%). In support to these results, Shah et al. (2017) found that there is a significant relationship between NLR and PAD. Also, these results came in agreement with Kuo et al. (2017) who found that increased neutrophil counts reflected oxidative stress, and that lower lymphocyte counts reflected a deterioration of nutritional status. In support to current study, Criqui and Aboynas (2015) observed that the high cholesterol is a significant contributor to PADs. In most studies, total cholesterol is associated with prevalent PADs in multivariable analyses. Also, in support to current study Criqui and Aboynas (2015) observed that triglycerides seem to be associated with PADs. In agreement results of current study Garimella et al. (2014) observed that hyperphosphatemia is associated with PAD in patients with end-stage renal disease.

CONCLUSION

     The neutrophil-lymphocyte ratio (NLR) was a highly sensitive predictor of peripheral arterial diseases (PADs) among regular hemodialysis patients.

REFERENCES

  1. Aboyans V, Ricco JB, Marie EL, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M, Carlo MD, Debus S, Klein CE, Kahan T, Kownator S, Mazzolai L, Naylor AR, Roffi M, Vlachopoulos C and Desormais I, (2018): 2017 ESCGuidelines on the diagnosis and treatment of peripheral arterial diseases. Eur Heart J., 39:763–821.
  2. Arroyo D, Betriu A, Valls J, Jose L, Gorriz, Pallares V, Abajo M, Gracia M, Valdivielso JM and Fernandez E, (2017): Factors influencing pathological ABI values along the chronic kidney disease spectrum: The NEFRONA study. Nephrol Dial Transplant. 32: 513–520.
  3. Chen J, Mohler ER,  Xie D, Michael G, Raymond S, Townsend R, Lawrence J, Appel, Dominic, Akinlolu, Martin Schreiber J, Louise F, Strauss, Zhang X,Wang MS and Hamm L, (2012): Risk factors for peripheral arterial disease among patients with chronic kidney disease. Am J Cardiol., 110: 136–141
  4. Criqui MH and Aboyans V (2015): Epidemiology of peripheral artery disease Circ. Res., 116: 1509-1526,
  5. Garimella PS and Hirsch AT (2014): Peripheral artery disease and chronic kidney disease: clinical synergy to improve outcomes. Adv Chronic Kidney Dis., 21(6):460-471.
  6. Kim NY, Chun DH, Kim SY, Kim NK, Baik SH, Hong JH, Kim KS and Shin C (2019): Prognostic value of  NLR for predicting 1-year survival of patients undergoing cytoreductive surgery with HIPEC. J Clin Med., 8(5): 589.
  7. Kuo IC, Huang JC, Wu PY, Chen SC, Orc ID, Chang JM and Chen HC (2017): A low geriatric nutrition risk index is associated with progression to dialysis in patients with chronic kidney disease. Nutrients., 9(11):1228.
  8. Liu CC, Ko HJ, Liu WS, Hung CL, Hu KC, Yu LY and Shih SC (2019): Neutrophil-to-lymphocyte ratio as a predictive marker of metabolic syndrome. Medicine (Baltimore), 98(43):e17537.
  9. Ouellet, Malhotra R, Penne EL, Usvya L, Levin NW and Kotanko P (2016): NLR as a predictor of survival in chronic hemodialysis patients,” Clinical Nephrology., 85(4):191–198.
  10. Shah B, Attubato M and Babaev A (2017): Relationship between neutrophil-lymphocyte ratio and severity of lower extremity peripheral artery disease Int. J., Cardiol. 228 201-4
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  12. Valga F, Monzon T, Henriquez F, Pérez GA, Diálisis C, Avericum SL, Palmas L, Canaria G, Canarias I and Spain T (2019): Prognostic role of neutrophil-to-lymphocyte ratio for mortality in incident hemodialysis patients. Nephrol Dial Transplant., 39(3):223-338.


العلاقة النسبية بين الخلايا المتعادلة البيضاء إلى الخلايا الليمفاوية کمؤشر لأمراض الشرايين الطرفية فى مرضى الاستصفاء الدموى المتکرر

عمرو عبد الخالق الحشاش*، صفوت فراج*، حازم أيوب*، محمد الفيشاوي**

قسمى الأمراض الباطنة* والاشعة التشخيصية**، کلية الطب، جامعة الأزهر

E-mail: aaelhashash@gmail.com

خلفية البحث: مرض الشرايين الطرفيه مرض شائع في مرضى الکلي المعاشين علي الاستصفاء الدموي، وتعتبر العلاقة النسبية بين الخلايا المتعادلة البيضاء إلى الخلايا الليمفاوية مؤشر على شدة ومدى التهاب وتصلب الشرايين في المرضى الذين يعانون من قصور الکلى والقلب والأوعية الدموية.

الهدف من البحث: تقييم العلاقة النسبية بين الخلايا المتعادلة البيضاء إلى الخلايا الليمفاوية کمؤشر لأمراض الشرايين الطرفية فى مرضى الاستصفاء الدموى المتکرر.

المرضى وطرق البحث: أجريت هذه الدراسة المقطعية في وحدة غسيل الکلى بمستشفى الحسين الجامعي على مدى ستة أشهر من يناير إلى يوليو 2020 على 40 مريضا من مرضى الغسيل الکلوى. وقد تم تسجيل البيانات الديموغرافية والمعلومات السريرية والبيانات المختبرية بما في ذلک صورة الدم الکاملة والکالسيوم والفوسفات والألبومين والکوليسترول والدهون الثلاثية والبروتين الدهني عالي الکثافة والبروتين الدهني منخفض الکثافة وملف الحديد کما تم قياس مؤشر الکاحل والعضد في جميع المرضى و تشخيص اعتلال الشرايين المحيطية إذا کان مؤشر الکاحل إلى العضد أقل من أو يساوى 0.9. کما تم إجراء الموجات فوق الصوتية المزدوجة للجهاز الشرياني لکلا الطرفين السفليين للمرضى إذا کان مؤشر الکاحل إلى العضد أقل من أو يساوى 0.9.

نتائج البحث: کان هناک 29 ذکورا˝ (72.5٪) و 11 إناثا˝ (27.5٪). وکان متوسط العمر لجميع المرضى الخاضعين للدراسة 43.2 ± 10.3 سنة. کما کان هناک 7 من مرضى السکري (17.5٪) و 27 من مرضى إرتفاع ضغط الدم (67.5٪). وفيما يتعلق بصورة الدم الکاملة، کان متوسط کرات الدم البيضاء، والخلايا المتعادلة، والخلايا الليمفاوية، والنسبة بين الخلايا المتعادلة الى الخلايا الليمفاويه، والهيموجلوبين والصفائح الدموية (6.5 ± 1.7) ×310 خلايا/ ميکرولتر، (4.3 ± 1,) ×310 خلايا/ ميکرولتر ، (1.75±  53) ×310 خلايا/ ميکرولتر، (2.73 ± 1.3) ،( 10.8± 2.3) (جم / ديسيلتر) و (234.7 ± 95.9) ×310 خلايا/ ميکرولتر على التوالي. وفيما يتعلق بملف الدهون، کان متوسط الکوليسترول الکلي و البروتين الدهنى عالى الکثافة و الدهون الثلاثية 214,7 مجم / ديسيلتر، 41.9 مجم / ديسيلتر، 172.2 مجم / ديسيلتر، على التوالي. أما فيما يتعلق بألبومين المصل، ومصحح الکالسيوم، ومصل الفسفور، وناتج ضرب الکالسيوم فى الفسفور و هرمون الغدة الجار درقية فقد کان المتوسط 3.99 ± 0.5 (جم / ديسيلتر)، 8.3 ± 0.6 (مجم / ديسيلتر)، 5.22 ± 1.1 مجم / ديسيلتر، 43.7 ± 11.2 و 722.1 ± 477.7 (ميکروغرام / مل) على التوالي. أما عن مؤشر الکاحل إلى العضد، فقد کان هناک 13 مريضًا (32.5٪) ≤0.9 بينما کان هناک 27 مريضًا (67.5٪) >0.9.

الاستنتاج: العلاقة النسبية بين الخلايا المتعادلة البيضاء إلى الخلايا الليمفاوية مؤشر لأمراض الشرايين الطرفية فى مرضى الاستصفاء الدموى المتکرر.

الکلمات الدالة: مرض الشرايين الطرفية في المرضى المعاشين على الاستصفاء الدموي المتکرر، مؤشر الکاحل إلى العضد، العلاقة النسبية بين الخلايا المتعادلة البيضاء إلى الخلايا الليمفاوية.

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