Neutrophil-to-lymphocyte ratio is associated with sarcopenia risk in overweight maintenance hemodialysis patients

BACKGROUND: Sarcopenia is prevalent among hemodialysis patients and is
associated with poor outcomes. The neutrophil-to-lymphocyte ratio (NLR), an
easily obtainable marker of inflammation, may predict sarcopenia risk. This
study aimed to investigate the association between NLR and sarcopenia risk in
maintenance hemodialysis patients, examining this association in the context of
obesity.
METHODS: This cross-sectional study included 411 maintenance hemodialysis
patients. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia
criteria-2019 (AWGS 2019). Body composition was assessed using bioelectrical
impedance analysis. Logistic regression models examined associations between NLR
and sarcopenia risk, adjusting for potential confounders. Analyses were
stratified by obesity status.
RESULTS: The prevalence of sarcopenia was 51% (95% CI: 45.1-54.9%), with 37.2%
classified as sarcopenic non-obese and 13.6% as sarcopenic obese. In fully
adjusted models, each unit increase in NLR was associated with 10% higher odds
of sarcopenia overall (OR 1.10, 95% CI: 1.00-1.21, p = 0.048). This association
remained significant in sarcopenic obese patients (OR 1.15, 95% CI: 1.00-1.32,
p = 0.049). Patients in the highest NLR tertile had 1.95 times higher odds of
sarcopenia compared to the lowest tertile (95% CI: 1.12-3.40, p = 0.018), with a
significant trend across tertiles (p-trend = 0.015).
CONCLUSIONS: NLR is independently associated with sarcopenia risk in
hemodialysis patients, including those with obesity. These findings suggest NLR
could serve as a simple, cost-effective tool for identifying hemodialysis
patients at high risk of sarcopenia, potentially facilitating early intervention
strategies.

DOI: 10.1186/s12891-025-08291-x
PMCID: PMC11721321
PMID: 39794771 [Indexed for MEDLINE]

Conflict of interest statement: Declarations. Ethics approval and consent to
participate: Good clinical care guidelines were followed, and the guidelines
were established as per the Helsinki Declaration 2008. All the participants were
given clear instructions about the study before the start of the study. Written
informed consent was obtained from the patients in the vernacular language for
study participation. No identifying information or images have been included in
the original article, which was submitted for publication in an online
open-access publication. The entire methodology and protocol were approved by
the Institutional Ethical Committee of Shri M P Shah Government Medical College,
Jamnagar, Gujarat, India. The study protocol was reviewed and approved by the
institutional review board or ethics committee. (approval number:
03/01/2023).Our study is not a clinical trial(so clinical trial registration
number is not applicable). Consent for publication: Not Applicable. Competing
interests: The authors declare no competing interests.