الفهرس 
Chapter (I): Frailty In End Stage Renal DiseaseOnly 14 pages are availabe for public view
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Abstract
The aim of this study was to study the association of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and frailty in maintenance hemodialysis patients and their effect on their outcome.
In order to achieve this aim, a case control study was conducted at Dialysis unit of National institute of liver and endemic diseases (Embaba Tropical hospital), Egypt on 80 patients on regular maintenance hemodialysis (MDH), according to the Till Burg Frailty Index, they were divided into two equal groups; group (1) included 40 HD patients who were assigned to the frailty group (case group), group (2) included 40 HD patients who were not assigned to frailty group (considered as control group). All selected patients were subjected to full history taken, thorough clinical examination and laboratory investigations.
Regarding basic demographic data, our results showed that patients in the frailty group had statistically significant higher ages and longer dialysis durations than those in the non-frailty group. There was no statistically significant difference between both groups regarding gender distribution. Further statistical analysis showed that there was a statistical significance positive correlation between Tilburg frailty indicator and age, and dialysis duration. Multivariate analysis showed that increased dialysis duration is one of the significant factors associated with frailty among the studied cases.
Regarding anthropometric characteristics, our results showed that frailty patients were having significantly lower BMI and MAC while there was no statistically significant difference between both groups regarding WC. Further statistical analysis showed that there was a significant negative correlation between both NLR and PLR and MAC. Also, there was a significant negative correlation between Tilburg frailty indicator and MAC.
Summary
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Regarding Laboratory findings, our results showed that frailty patients had lower phosphorus levels, Hb%, HDL, and lymphocytic count compared to non-frailty patients, and had significantly higher total cholesterol, LDL, TG3, serum iron and TIBC compared to non-frailty patients.
Further statistical analysis showed that there was a statistically significant positive correlation between NLR and PTH, TLC, TG and a statistical significance negative correlation Ca, Hb% and HDL. Also, there was a statistical significance positive correlation between PLR and serum iron and a statistically significant negative correlation between PLR and Na, Hb and HDL. Also, there was a statistical significance positive correlation between Tilburg frailty indicator and Iron, cholesterol, TG, and LDL and a statistical significance negative correlation between Tilburg frailty indicator and PO4, Hb, Lymphocyte, platelets and HDL. Multivariate analysis showed that Po4 level is an independent factor associated with frailty among the studied cases.
Regarding clinical outcomes, our results showed that frailty patients had higher prevalence of hospitalization and physician visits than non-frailty patients while there was no statistically significant difference between both groups regarding prevalence of disability and mortality. Further statistical analysis showed that there was a significant relation between Tilburg frailty indicator and prevalence of hospitalization and physician’s visits.
Regarding NLR and PLR, our results showed that frailty patients had significantly higher ratios than non-frailty patients. Further statistically significant analysis showed there was a statistical significance positive correlation between NLR and PLR. There was a statistical significance positive correlation between Tilburg frailty indicator and both NLR and PLR. Multivariate analysis showed that both NLR and PLR are the significant factors associated with frailty among the studied cases.
Summary
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NLR at cut off <1.64 had sensitivity 70%, specificity 70% and accuracy 70% in diagnosis of frailty while PLR at cut off >96.88 had sensitivity 62.5%, specificity 80% accuracy 71.3% in diagnosis of frailty.