Association of Neutrophil-to-Lymphocyte Ratio and C-Reactive Protein-to-Albumin Ratio with Renal Anemia in Maintenance Hemodialysis Patients

Abstract

Objectives: To explore the correlation of the neutrophil-to-lymphocyte ratio (NLR) and the C-reactive protein-to-albumin ratio (CRP/ALB, CAR) with renal anemia in maintenance hemodialysis (MHD) patients.

Methodology: Clinical data of 275 MHD patients admitted to the Hemodialysis Center of the First Affiliated Hospital of Qiqihar Medical University from December 2022 to December 2024 were retrospectively analyzed. These patients were divided into an anemia (hemoglobin [Hb] < 110 g/L) and a non-anemia (Hb ≥ 110 g/L) group based on the presence of renal anemia. Patients in the anemia group were further stratified by anemia severity into a mild subgroup (Hb > 90 g/L), a moderate subgroup (60 g/L < Hb ≤ 90 g/L), and a severe subgroup (Hb ≤ 60 g/L). The levels of NLR and CAR were measured and compared across all groups. Receiver operating characteristic (ROC) curves were used to analyze the value of each indicator in evaluating the discriminative ability of each indicator for renal anemia status. Additionally, the relationship between NLR/CAR levels and the severity of anemia was evaluated.

Results: A total of 92 patients (33.5%) were diagnosed with renal anemia. The levels of NLR and CAR in the anemia group were significantly higher than those in the non-anemia group (P < 0.05). The ROC analysis showed that the areas under the curves (AUCs) for NLR and CAR in diagnosing renal anemia in MHD patients were 0.825 and 0.894, respectively (P < 0.05). With increasing anemia severity, NLR and CAR levels increased significantly (P < 0.05).

Conclusion: NLR and CAR exhibit significant discriminative ability for renal anemia in MHD patients and are correlated with the severity of the condition.