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Higher neutrophil-to-lymphocyte ratio linked to peritoneal dialysis peritonitis riskHigher blood ratio linked to infection risk in peritoneal dialysis patients

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Key Takeaway
Consider NLR as a potential biomarker for peritonitis risk in peritoneal dialysis patients, but interpret findings cautiously due to the observational design.

This was a retrospective case-control study at a single center involving 178 patients on peritoneal dialysis (89 cases with peritonitis and 89 matched controls). The exposure was the neutrophil-to-lymphocyte ratio (NLR) measured from routine blood tests during a 3-month period preceding the peritonitis event for cases, or a corresponding pre-index period for controls. The comparator was the lowest tertile of NLR (NLR < 1.24).

The main result was that a 1-unit increase in ln(NLR) was independently associated with a higher risk of peritoneal dialysis-associated peritonitis (PDAP), with an odds ratio of 2.25 (95% CI: 1.26–4.02, p = 0.006). A consistent positive association was also noted for the highest NLR tertile (NLR ≥ 1.24) versus the lowest tertile, though specific effect sizes and absolute numbers were not reported.

Safety and tolerability data were not reported. Key limitations include the retrospective design, single-center setting, and potential selection bias from the matched case-control design. The practice relevance is that NLR may serve as a biomarker to predict future risk of peritoneal dialysis-associated peritonitis, but the association is observational and does not imply causation.

Researchers looked at whether a routine blood measure called the neutrophil-to-lymphocyte ratio (NLR) might be linked to peritoneal dialysis-associated peritonitis. The study included 178 patients on peritoneal dialysis at a single center, comparing 89 people who had peritonitis with 89 matched controls.

They found that a higher NLR was independently associated with an increased risk of peritonitis. For each one-unit increase in the natural log of NLR, the odds of peritonitis were about 2.25 times higher. The highest NLR group also showed a consistent positive association with peritonitis risk.

No safety issues were reported because the study only measured a blood ratio. The main reason to be careful is that this was a small, retrospective, single-center study, and matched case-control designs can introduce selection bias. Observational findings like these need validation in prospective studies before any clinical use.

What readers should take from this is that NLR may serve as a biomarker to help predict future peritonitis risk, but it does not prove cause and effect, and it should not guide treatment decisions on its own.

What this means for you:
A higher blood ratio was linked to more peritonitis risk, but the study was small and observational.

Study Details

Study typeCohort
EvidenceLevel 3
PublishedApr 2026
View Original Abstract ↓
BackgroundThe neutrophil-to-lymphocyte ratio (NLR) is a biomarker of systemic inflammation and has been associated with adverse outcomes in dialysis patients. Its role in predicting the future risk of peritoneal dialysis-associated peritonitis (PDAP) before clinical onset remains unclear.ObjectiveTo evaluate the association between pre-peritonitis NLR levels and the risk of developing PDAP.MethodsWe conducted a retrospective, matched (1:1) case–control study involving patients on peritoneal dialysis at a single center between January 2010 and October 2024. Cases were patients who developed a first episode of PDAP (diagnosed per ISPD guidelines). Controls were matched to cases on sex and age (±3 years). The exposure was NLR measured from routine blood tests during a 3-month period preceding the peritonitis event for cases, or a corresponding pre-index period for controls. Logistic regression analysis was used to assess the association.ResultsA total of 178 patients (89 cases and 89 matched controls) were included in the analysis. In conditional logistic regression models accounting for the matched design, a higher NLR was independently associated with an increased risk of PDAP. When analyzed as a continuous variable (per 1-unit increase in ln(NLR)), the fully adjusted odds ratio (OR) was 2.25 (95% confidence interval [CI]: 1.26–4.02, p = 0.006). When NLR was categorized into tertiles, patients in the highest tertile (NLR ≥ 1.24) demonstrated a consistent positive association with peritonitis risk compared to those in the lowest tertile (NLR 
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