A Retrospective Analysis Of Hematologic Parameters in Patients With Early Diabetic Kidney Disease

Abstract Objective: To retrospectively analyze the hematologic parameters in patients with early Diabetic Kidney Disease (DKD) to define potential biomarkers that can be used to predict early DKD. Methods: 134 diabetic patients without nephropathy and 49 patients with early DKD were enrolled for this study and the hematologic parameters were retrospectively analyzed. Paired comparison was conducted by T-test and the predicting value of any statistically different parameter was tested using the Receiver Operating Characteristic curve (ROC) analysis model. Results: The number of neutrophils (N) was higher (P <0.001) while monocyte (M) was lower (P <0.01) in the early DKD group than that of the DM group without nephropathy. In addition, neutrophil to lymphocyte ratio (NLR) was higher while platelet to lymphocyte ratio (PLR) was significantly lower in the early DKD group(P <0.001). Results from ROC curve analysis showed the sensitivity and specificity of PLR to predict early DKD were 83.7% and 82.6%, respectively. Conclusions: PLR may be a potential hematologic parameter that can be used to predict early DKD.

Keywords： retrospective analysis, diabetic kidney disease, platelet to lymphocyte ratio

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Introduction

Diabetes mellitus (DM) is an endocrine system disease that is prevalent and causes health burden worldwide.1 Over 10% of the world’s population is estimated to have DM or be at high risk of developing DM.2 Patients with DM whose glucose levels are not well controlled usually present with many complications such as DKD, diabetic retinopathy, diabetic foot, atherosclerotic cardiovascular diseases, and heart failure.3 As the most common complication in DM patients, DKD is the main cause of death or renal failure in end-stage renal disease (ESRD).4 If the kidney damage in patients with DM can be detected early， further damage will be prevented. Although the early diagnosis of DKD mainly depends on the detection of microalbuminuria in the clinical setting, the microalbuminuria test is easily affected by various factors.5 Therefore, it is of great significance to explore more sensitive, specific, and noninvasive biomarkers for early diagnosis of DKD.

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Platelet to lymphocyte ratio (PLR) is a new type of nonspecific inflammatory marker, which has been widely used in the monitoring and prognosis prediction of many respiratory, and digestive diseases and tumors.6 Previous studies demonstrated that the PLR of systemic lupus erythematosus (SLE) patients with nephritis is higher than that of SLE patients without nephritis, indicating that PLR may be used to predict the occurrence of lupus nephritis.7 Another report showed that patients with higher PLR had lower survival rates and worse prognoses.8 A recent study showed that PLR and neutrophil count are independent prognostic factors for metastatic renal cell carcinoma (mRCC).9 In addition, PLR can be used to predict disease activity in SLE patients and the best PLR cut-off value was 132.9.10

Therefore, PLR is of great value in the prediction of progression and prognosis of many diseases. Currently, there are few reports on PLR used to predict DKD. A recent report has found that Type 2 diabetic patients with proteinuria had significantly higher PLR levels than that of diabetic patients without proteinuria.11 Therefore, the purpose of this study is to explore whether PLR can be used to predict early DKD in patients with DM.

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Materials and Methods

One hundred and eighty-three patients with type 2 diabetes who were hospitalized in Jingzhou Central Hospital, Hubei Province from August 1, 2019 to December 1, 2019 were enrolled for this study. Forty-nine cases were DM group with early DKD and 134 cases were DM group with normal renal function. The inclusion criteria for the groups were as follows :(1) The DM group with early DKD had Urinary Albumin Creatinine Ratio (UACR) ≥30 mg/g but < 300 mg/g; Simultaneously, DM group with normal renal function were UACR < 30 mg/g and glomerular filtration rate (eGFR) ≥30 ml / (min•1.73m2 ) according to the American Diabetes Association (ADA) guideline in 2021;(2) The enrolled patients have not taken drugs affecting renal function recently. The exclusion criteria were as follows: (1) there are other endocrine diseases except for DM, and patients with cardiovascular and urinary system immune diseases; (2) Patients with primary nephropathy, renal artery stenosis, and renal diseases caused by heart, liver and other systemic diseases.

The blood samples were collected in the EDTA-K2 anticoagulant tubes. The monocyte (M), neutrophil (N), platelet (P) and lymphocyte (L) were measured by Sysmex XN3000.

The GraphPad Prism 5.0 was used for data analysis. Chi-square was used to analyze the difference of age and gender between the groups. The independent sample t-tests were used to compare the differences between early DKD group and the DM group with normal renal function. The receiver operating curve (ROC) and the area under the curve (AUC) were calculated to compare each parameter. The AUCs of these comparative biomarkers were compared by the Delong method. A P-value <0.05 was considered statistically significant.

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