Evaluation of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Diabetic Kidney Disease Patients: A Hospital-Based Cross-Sectional Analysis
DOI:
https://doi.org/10.26911/theijmed.2026.11.1.890Abstract
Background: Diabetes mellitus represents a chronic metabolic disorder with globally increasing prevalence and is one of the leading causes of microvascular complications such as diabetic kidney disease (DKD). Chronic inflammation plays a crucial role in DKD pathogenesis, prompting exploration of simple inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). This study aimed to determine the relationship between NLR and PLR values with the incidence of DKD.
Subject and Methods: This cross-sectional study employed consecutive non-random sampling technique. The study population consisted of all patients visiting Cinta Kasih Tzu Chi Cengkareng Hospital from January to April 2025, totaling 128 respondents. Secondary data from medical records were analyzed using Chi-Square test to determine associations between NLR and PLR (categorized as high vs low) with diabetic kidney disease incidence. Statistical analysis employed Chi-Square test with significance set at p<0.050.
Results: Among 128 respondents, 64 (50.00%) were diagnosed with diabetic kidney disease. High NLR group comprised 101 respondents (78.90%), with 50 (39.10%) having DKD. High PLR group totaled 32 respondents (25.00%), with 19 (14.80%) having DKD. NLR demonstrated no significant association with DKD incidence (PR= 0.96; CI95% 0.48 to 1.41; p=0.828). PLR also showed no significant association with DKD incidence (PR= 0.89; CI95% 0.52 to 1.53; p=0.552).
Conclusion: Neither NLR nor PLR demonstrates a significant relationship with diabetic kidney disease incidence at Cinta Kasih Tzu Chi Cengkareng Hospital. These findings suggest that NLR and PLR cannot be used as standalone predictors for DKD and should be considered alongside other clinical parameters in comprehensive diabetes management protocols.
Keywords:
Diabetic nephropathy, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, Diabetes MellitusReferences
Akmal TH, Hikmatul T, Sari D, Rahman A (2024). Hubungan rasio neutrofil limfosit terhadap komplikasi kardio-vaskular pada pasien penyakit ginjal kronik hemodialisis. J Penyakit Dalam Indones. 11(1): 1–8. Doi: 10.7454/jpdi.v11i1.1524
Alicic RZ, Rooney MT, Tuttle KR (2017). Diabetic kidney disease. Clin J Am Soc Nephrol. 12(12): 2032–2045. Doi: 10.2215/CJN.11491116
de Boer IH, Caramori ML, Chan JCN, Heerspink HJL, Hurst C, Khunti K, Liew A, et al. (2020). KDIGO 2020 clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int. 98(4): S1–S115. Doi: 10.1016/j.kint.2020.-06.019
Bommer C, Sagalova V, Heesemann E, Manne-Goehler J, Atun R, Bärnig-hausen T, Davies J, Vollmer S (2018). Global economic burden of diabetes in adults: projections from 2015 to 2030. Diabetes Care. 41(5): 963–970. Doi: 10.2337/dc17-1962
Duman TT, Aktas G, Atak BM, Kocak MZ, Erkus E, Savli H (2019). Neutrophil to lymphocyte ratio as an indicative of diabetic control level in type 2 diabetes mellitus. Afr Health Sci. 19(1): 1602. Doi: 10.4314/ahs.v19i1.-35
Findi Z, Pratama R, Sari L, Wahyuni S (2023). Hubungan rasio neutrofil-limfosit dengan derajat keparahan COVID-19 pada pasien diabetes. J Ilmu Kesehatan Indones. 4(2): 124–130.
Firdaus DY, Guyansyah A, Thenu U, Denggo SD (2022). Comparison of neutrophil lymphocyte ratio (NLR), mean platelet volume (MPV) and platelet lymphocyte ratio (PLR) in preeclampsia and normotensive pregnancies. J Med Sci. 54(4): 340–347. Doi: 10.19106/JMedSci005404-202204.
Huang W, Huang J, Liu Q, Lin F, He Z, Zeng Z, He L (2015). Neutrophil–lymphocyte ratio is a reliable predic-tive marker for early-stage diabetic nephropathy. Clin Endocrinol (Oxf). 82(2): 229–233. Doi: 10.1111/cen.-12576.
International Diabetes Federation (2024). IDF diabetes atlas. Brussels: IDF.
Khairani S, Dewi R, Putri A, Sari M (2022). Literature review: korelasi neutrophil lymphocyte ratio dan platelet lym-phocyte ratio terhadap kejadian kaki diabetes. Homeostasis. 5(2): 411–418. Doi: 10.20527/ht.v5i1.6291.
Khandare S, Chittawar S, Nahar N, Dubey T, Qureshi Z (2017). Study of neutro-phil-lymphocyte ratio as novel marker for diabetic nephropathy in type 2 diabetes. Indian J Endocrinol Metab. 21(3): 387. Doi: 10.4103/-ijem.IJEM_476_16
Lauddin EA, Nurulita A, Muhadi D (2019). Analisis rasio netrofil limfosit dan rasio platelet limfosit terhadap penanda gangguan ginjal pada penyakit systemic lupus erythema-tosus di RSUP dr. Wahidin Sudiro-husodo tahun 2017–2018. Intisari Sains Medis. 10(1): 362. Doi: 10.-15562/ism.v10i1.362
Li L, Shen Q, Rao S (2022). Association of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with diabetic kidney disease in Chinese patients with type 2 diabetes: a cross-sectional study. Ther Clin Risk Manag. 18: 1157–1166. Doi: 10.2147/-TCRM.S393135
Magliano DJ, Boyko EJ (2021). IDF diabetes atlas, 10th edition. Brussels: International Diabetes Federation.
Mboi N, Syailendrawati R, Ostroff SM, Elyazar IR, Glenn SD, Rachmawati T, Nugraheni WP, et al. (2022). The state of health in Indonesia’s provin-ces, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Glob Health. 10(11): e1632–e1645. Doi: 10.1016/-S2214-109X(22)00371-0
Qiao Y, Wang P, Qi J, Zhang L, Gao Y (2021). Platelets in chronic kidney disease: a link between hemostasis, inflammation, and cardiovascular disease. Int J Mol Sci. 22(17): 9952. Doi: 10.3390/ijms22179952
Rias YA, Rosyad YS, Chipojola R, Wiratama BS, Safitri CI, Weng SF, Yang CY, Tsai HT (2020). Effects of spirituality, knowledge, attitudes, and practices toward anxiety regarding COVID-19 among the general population in Indonesia: a cross-sectional study. J Clin Med. 9(12): 3798. Doi: 10.3390/jcm91-23798
Rumondang S, Bisuk PS, Umboh ORH (2022). Pengaruh inflamasi mikro terhadap penyakit ginjal pada pasien diabetes melitus tipe-2. Med Scope J. 4(1): 40–47. Doi: 10.35790/msj.-v4i1.44682
Samsu N (2021). Diabetic nephropathy: challenges in pathogenesis, diagnosis, and treatment. Biomed Res Int. 2021: 1497449. Doi: 10.1155/2021/1497449
Sapra A, Bhandari P (2017). Diabetes. In: StatPearls. Treasure Island (FL): StatPearls Publishing.
Tolla N, Sari P, Dewi L, Rahman F (2019). Analisis indeks trombosit dan rasio trombosit limfosit sebagai penanda kerusakan ginjal pada penderita hipertensi berbagai derajat. Medica Arteriana. 1(2): 59–65. Doi: 10.26-714/medart.1.2.2019.7-14.
Wahidin M, Achadi A, Besral B, Kosen S, Nadjib M, Nurwahyuni A, Rono-atmodjo S, et al. (2024). Projection of diabetes morbidity and mortality till 2045 in Indonesia based on risk factors and NCD prevention and control programs. Sci Rep. 14(1): 5424. Doi: 10.1038/s41598-024-545-63-2.
Zhao Y, Wang C, Li S, Song Y, Wang D, Jiang J, Zhao Z (2020). Role of inflammation in diabetic kidney disease and the impact of sodium–glucose cotransporter 2 inhibitors. Front Immunol. 11: 1729. Doi: 10.3389/fimmu.2020.01729.
