Association of Estimated Glomerular Filtration Rate, Neutrophil-to-Lymphocyte Ratio, and Platelet-to-Lymphocyte Ratio at the Initiation of Hemodialysis with Mortality

Abstract Introduction: In this study, we aimed to retrospectively examine the effects of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and glomerular filtration rate (GFR) at the initiation of hemodialysis on mortality in hemodialysis patients. Methods The study was conducted retrospectively on patients who underwent hemodialysis in the province of Hatay between January 2010 and January 2025. Inclusion criteria were being on hemodialysis for at least 3 months and being older than 18 years. Exclusion criteria included home hemodialysis, peritoneal dialysis, age under 18 years, and undergoing hemodialysis for less than 3 months. Results A total of 1136 patients were included in the study. The mean age of the patients was 64.7 ± 13.42 years. The mean GFR at the initiation of hemodialysis was 8.48 ± 3.76 mL/min/1.73 m². No significant association was detected between NLR, PLR, and mortality. According to logistic regression analysis, the independent factors significantly associated with mortality were age, diabetes, and GFR category (p < 0.05). Each one-year increase in age increased the risk of death by 1.031 times (p < 0.001). The risk of death was approximately 1.76 times higher in diabetic patients compared with non-diabetics (p < 0.001). Patients with GFR < 7 mL/min/1.73 m² had 2.53 times higher mortality risk compared with those with GFR > 10 mL/min/1.73 m² (p = 0.008). Conclusion This study demonstrates that age, the presence of diabetes, and low initial GFR are significant determinants of mortality in hemodialysis patients. These findings highlight the importance of early intervention and management of comorbidities in this population.