Platelet-To-Lymphocyte Ratio and Arteriovenous Fistula for Hemodialysis: An Early Marker to Identify AVF Dysfunction.

Abstract

The KDOQI guidelines (Kidney Disease Outcomes Quality Initiative) recommend autologous arteriovenous fistula (AVF) as the primary vascular access in hemodialysis patients because of the higher quality of life and lower complication rates if compared to arteriovenous grafts (AVGs) or central venous catheter (CVC). Several studies used various inflammatory biomarkers to evaluate the association between systemic inflammation and AVF dysfunction. A novel inflammatory biomarker, the platelet-lymphocyte ratio (PLR), is a useful and easy laboratory parameter that can reveal systemic inflammation. Our study aimed to evaluate the relationship between PLR value changes over time and AVF dysfunction. The impact of PLR on our outcome showed a trend close to the significance (OR: 4,9; 95%CI: [0.84-28.5]; p = 0.08) but the slope was not linear. Therefore, we performed the same analysis splitting the patients by the median PLR value and we highlighted a significant relationship between our outcome and the PLR (log-transformed) for PLR-value under the median value (OR: 9.97; 95%CI: [2.53-39.25]; p = 0.001). Furthermore, in patients with PLR above the median value, the interaction visit-PLR showed an impact close to the statistical significance (OR: 7.7; 95%CI: [0.81-72.97]; p = 0.07). PLR (log-transformed) was positively correlated with AVF age (Rho: 0.254, p = 0.002).