Increased neutrophil count Is associated with the development of chronic kidney disease in patients with diabetes

This study aims to investigate the potential association of peripheral inflammatory blood cell parameters with the incidence and progression of chronic kidney disease (CKD) in patients with diabetes.The cross-sectional study included 1192 subjects with diabetes derived from one center. The cohort study included 2060 subjects with diabetes derived from another two centers followed up for 4 years. Logistic regression and Cox proportional hazards models were used to evaluate the association of peripheral inflammatory blood cell with CKD.In the cross-sectional study, neutrophil count performed best as an independent risk factor for CKD (odds ratio 2.556 [95% confidence interval 1.111, 5.879]) even after 1:1 case-control matching for age, gender, history of high blood pressure and duration of diabetes. Spline regression revealed a significant linear association of CKD incidence with continuous neutrophil count in excess of 3.6 × 109 /L. In the cohort study, subjects were grouped based on tertile of neutrophil count and neutrophil-to-lymphocyte ratio. Cox regression analysis results showed that only neutrophil count was independently associated with CKD progression (the highest group vs. the lowest group, hazard ratio 2.293 [95% confidence interval 1.260, 4.171]) after fully adjusting for potential confounders. The cumulative incidence of CKD progression in patients with diabetes gradually increased with increasing neutrophil count (53 (7.7%) subjects in the lowest group vs. 60 (8.2%) in the middle group vs. 78 (12.2%) in the highest group).This study suggested that neutrophil count is an independent risk factor for progression of CKD in patients with diabetes.背景: 本研究旨在探讨糖尿病人中外周血炎性细胞参数与慢性肾脏疾病(CKD)的发生和发展之间的潜在相关性。 方法: 以1192名来自同一研究中心的受试者作为横断面研究。来自另外两个中心的2060名受试者随访4年，进入队列研究。采用Logistic回归和COX比例风险模型评价外周血炎性细胞与CKD的相关性。 结果: 在横断面研究中，即使在年龄、性别、高血压病史和糖尿病病程进行1:1病例对照匹配后，中性粒细胞计数仍然是CKD的最相关的独立危险因素(OR 2.556[95%CI 1.111，5.879])。样条回归显示CKD发病率与中性粒细胞计数持续超过3.6×109 /L呈显著线性相关。在队列研究中，受试者根据中性粒细胞计数和中性粒细胞/淋巴细胞比率的三分位进行分组。COX回归分析结果显示，在完全校正潜在混杂因素后，只有中性粒细胞计数与CKD进展独立相关(最高组vs.最低组，HR 2.293[95%CI 1.260，4.171])。随着中性粒细胞计数的增加，糖尿病患者CKD进展的累积发生率逐渐增加，最低组53例(7.7%)，中间组60例(8.2%)，最高组78例(12.2%)。 结论: 本研究提示中性粒细胞计数是糖尿病患者CKD进展的独立危险因素。.