The platelet/lymphocyte ratio, a marker of inflammation, may predict which end-stage renal disease (ESRD) patients with anemia will be resistant to treatment with erythropoiesis-stimulating agents (ESAs), according to a study.

Kultigin Turkmen, MD, associate professor of nephrology at Necmettin Erbakan University in Turkey, and colleagues examined the relationship between ESA resistance and inflammation in 104 hemodialysis patients using surrogates: the ESA hyporesponsiveness index (EHRI), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR). The researchers calculated the EHRI as the weekly dose of EPO divided by kilograms of body weight divided by the hemoglobin level. Patients taking steroids and those with iron deficiency, infection, recent hospitalizations, or a history of blood transfusions or hematologic malignancy were excluded.

EHRI correlated only with hemoglobin and PLR, but not with NLR, according to results published in Therapeutic Apheresis and Dialysis. When investigators compared PLR levels at the 25th, 50th, and 75th percentile of EHRI, PLR levels increased.

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“For the first time, our study demonstrated that PLR was independently associated with EHRI in HD patients,” Dr. Turkmen told Renal & Urology News. “One might consider measuring PLR, which is quite a simple and cheap method, to detect EPO resistance in an ESRD population.”

Platelets play a role in atherosclerosis and their interactions with a variety of cell types might spur inflammation in the arterial wall, the investigators explained. In addition, a low lymphocyte count may reflect an exaggerated immune reaction to physiologic stress and cortisol.

The researchers acknowledged that their study involved a small number of patients and a limited time frame. It also did not account for all potential confounders, such as hepcidin.