MO860NEUTROPHILS /LYMPHOCYTES RATIO: IS THERE ANY RELATION WITH ARTERIOVENOUS FISTULA EARLY FAILURE ON HEMODIALYSIS
Authors: Abid Hanen , Toumi Salma , Lahouimel Rania , Kharrat Emna , Ben Brahim Rimeh , Agrebi Ikram , Dammak Najla , Chaker Hanen , Kammoun Khaoula , Yaich Soumaya , Ben Hmida Mohamed 
Published: May 2021

Abstract

Background and Aims
The native arteriovenous fistula (AVF) is the vascular access point for hemodialysis (HD) in end-stage renal disease (ESRD) patients undergoing HD. The challenge in the follow up of any AVF is to reach a correct maturation state and a higher longevity. The neutrophils to lymphocytes ratio (NLR) and the platelets to lymphocytes ratio (PLR) have been reported in many papers to be prognostic indicators for the AVF failure which seems to be associated with high levels of NLR or PLR. This study aimed to evaluate the role of preoperative NLR and PLR in predicting early AVF failure.

Method
We conducted a retrospective study including 31 patients who are hemodialysis (HD) in our center and who benefited from an AVF confection during 2019 and 2020.
The threshold ratios found in the literature from which the risk of AVF early failure is significant are NLR&gt; = 2.5 and PLR&gt; = 150. These values have been considered the references in our work.

Results
The average age of our patients is 50 years (20-84 years). The sex ratio is equal to 1,38 (18 men and 13 women). 20 patients started HD when they were under 60 years old and 11 patients after the age of 60.
We noticed smoking, obesity, hypertension and diabetes respectively in 16%, 45%, 77%, and 32% of our patients. The causal nephropathy is respectively undetermined in 10 cases, interstitial in 7 cases, diabetic in 6 cases, glomerular in 5 cases and vascular in 3 cases.
The type of AVF is proximal in 19 cases (61%) and distal in 12 cases (38%).
The AVF failure occurred in 19%. The causes of AVF early failure are respectively a thrombosis in 3 cases, a stenosis in 2 cases and non maturing AVF in one case. The mean NLR is 4,47 (1,09 -17). The mean PLR is 193 (80-397). 74% of our patients have a NLR ≥2,5 and 26% less than 2,5. 61% of the patients have a PLR ≥150 and 39% less than 150. All the patients with an AVF failure have a NLR ≥2,5 however only 5 persons have a PLR ≥150.
Among the 6 patients with an AVF failure, the AVF is proximal in 5 cases and distal in one case.
We divided our population in two groups: group1 patients with an AVF failure (6 patients) and group2 who don’t have an AVF failure (25 patients). Afterwards, we have studied the correlations between these 2 groups with the NLR interval and PLR interval.
We didn’t find any significant correlation between the occurrence of AVF failure with the NLR interval (p=0,11) and PLR interval (p=0,22). We tried to find values of NLR and PLR for which we found a correlation with the AVF failure using the ROC curve. The best cut off to predict AVF failure is 3,45 for NLR and 204 for PLR.

Conclusion
We demonstrate throw this study that a high preoperative NLR and PLR can predict the early AVF less. These data may serve as a foundation to develop future research on the role of anti-inflammatory medications in the prevention of AVF failure think that required a larger series and more prolonged follow up.