White Cell Indices and NLR Across CKD Stages: Indicators of Subclinical Inflammation

Abstract

Objective: To investigate the distribution of neutrophil, lymphocyte, and other white blood cell (WBC) indices across various stages of chronic kidney disease (CKD) and assess their potential role as indicators of subclinical inflammation.
Study Design: It was Cross sectional study.
Place and Duration of Study: A cross-sectional study was conducted at the Nephrology Department, JPMC Karachi, in collaboration with Bahria University, from October 13, 2023, to May 15, 2024.
Materials and Methods: A total of 114 predialysis CKD patients were stratified into stages I–IV based on clinical and laboratory criteria. Complete blood counts, including total WBC count (×10⁹/L), neutrophil (%), lymphocyte (%), eosinophil (%), and monocyte (%), were recorded. The neutrophil-to-lymphocyte ratio (NLR) was calculated. WBC indices were compared across CKD stages using the Kruskal–Wallis test, and correlations with serum creatinine (mg/dL) were analyzed. All statistical analyses were performed using SPSS version 27.
Results: Of the 114 patients, 58.8% were female and 41.2% were male. Although median WBC counts and individual leukocyte subsets did not show statistically significant differences across CKD stages (p > 0.05), a progressive rise in NLR was observed with advancing CKD. This trend, while statistically insignificant, may still hold clinical value as it suggests underlying low-grade inflammation. Correlation analysis showed weak associations between WBC indices and serum creatinine, but the observed patterns indicate biological plausibility, supporting the potential role of these markers in disease monitoring.
Conclusion: Although not statistically significant, the rising NLR trend suggests possible subclinical inflammation. In low-resource settings, routine CBC parameters remain a practical and economical tool for early detection and monitoring in CKD.