Association of Neutrophil Lymphocyte Ratio and Mean Platelet Volume (MPV) on Arteriovenous Fistula Malfunction in Hemodialysis Patients at Prof. Dr. I.G.N.G. Ngoerah Hospital, Indonesia
Jessica Benedick *
Department of Surgery, Faculty of Medicine, Udayana University, Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali, Indonesia.
Dewa Ayu Made Adnya Swari *
Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, Udayana University, Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali, Indonesia.
Ketut Putu Yasa
Cardiothoracic and Vascular Endovascular Division, Department of Surgery, Faculty of Medicine, Udayana University, Prof Dr. IGNG Ngoerah Hospital, Denpasar, Bali, Indonesia.
I Ketut Sudartana
Digestive Division, Department of Surgery, Faculty of Medicine, Udayana University, Prof Dr. IGNG Ngoerah Hospital, Denpasar, Bali, Indonesia.
*Author to whom correspondence should be addressed.
Abstract
Background: Chronic kidney disease patients receiving maintenance haemodialysis depend on reliable vascular access; however, arteriovenous fistula (AVF) malfunction remains an important clinical problem.
Aims: This study aimed to evaluate the association of the neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV) with AVF malfunction within three months among patients undergoing maintenance haemodialysis at Prof. Dr. I.G.N.G. Ngoerah Hospital.
Place and Duration of Study: Department of Surgery, Medical Faculty of Udayana University, Prof Dr. IGNG Ngoerah Hospital, between January 2023 and December 2024.
Methodology: A retrospective cohort study was conducted among 72 patients with stage V chronic kidney disease who underwent AVF surgery at Prof. Dr. I.G.N.G. Ngoerah Hospital between January 2023 and December 2024. Pre-operative NLR and MPV were categorised as high or normal using cut-off values of 2.925 and 9.75 fL, respectively.
Results: Thirty-six patients experienced AVF malfunction, while 36 had normal AVF function. High NLR was observed in 29 of 36 patients with AVF malfunction and 1 of 36 patients with normal AVF function. High NLR was significantly associated with AVF malfunction (P = 0.000; RR = 5.800; 95% CI: 2.940–11.443). High MPV was present in 25 of 36 patients with AVF malfunction and 14 of 36 patients with normal AVF function and was also significantly associated with malfunction (P = 0.009; RR = 1.923; 95% CI: 1.124–3.289). Age, sex, nutritional status, hypertension, diabetes mellitus, and haemoglobin category were not significantly associated with AVF malfunction.
Discussion: The findings indicate that elevated pre-operative NLR and MPV were associated with a higher occurrence of AVF malfunction in the study population, whereas the evaluated demographic and clinical factors showed no significant associations.
Conclusion: Pre-operative NLR and MPV may have potential value as readily available markers associated with AVF malfunction. However, prospective multicentre studies are required before these parameters can be regarded as definitive predictive markers.
Keywords: Arteriovenous fistula, chronic kidney disease, haemodialysis, vascular access, neutrophil-to-lymphocyte ratio, mean platelet volume, AVF malfunction, systemic inflammation, thrombosis, vascular access failure