The neutrophil-to-lymphocyte (NLR) ratio has shown potential as an inflammatory biomarker for identifying individuals at increased risk of diabetic nephropathy (DN) occurrence and progression.
What is Diabetic Nephropathy?
DN is the name given to kidney damage caused by diabetes, where high blood sugar damages the small blood vessels in the kidneys, leading to impaired waste filtering, and potentially resulting in kidney failure. DN is a serious complication of diabetes and is a leading cause of end-stage renal disease and chronic kidney disease.
With appropriate support and treatment, it is possible to reduce the risk of developing DN, and early identification of DN can allow for disease progression to be slowed. Being able to predict patients at risk of DN could therefore be crucial to improving patient outcomes.
The Predictive Value of the NLR
This comprehensive meta-analysis utilised cohort and case-control studies from six databases to evaluate the association between NLR and the risk, progression, and mortality of DN.
39 studies involving 14 300 participants showed that DN patients had significantly elevated NLR levels compared to diabetic controls without nephropathy. Of the patients with DN, a higher NLR ratio was also associated with kidney function deterioration. The association between NLR ratio and mortality was insignificant, but subgroup analyses showed stronger associations in patients aged 60 years and older and those with a BMI over or equal to 25 kg/m2.
Clinical Implications for Diabetic Nephropathy
This study suggests that NLR could be used in the future as a biomarker to identify individuals with an increased risk of DN occurrence and progression. However, the predictive value of NLR as a biomarker across the clinical range of DN, from occurrence to progression to mortality, remains to be seen.
Given the potential bias and heterogeneity of the studies used in this analysis, these findings should be further explored with larger scale, standardised research before being considered for clinical practice.
Reference
Liu H et al. The predictive value of neutrophil-to-lymphocyte ratio for the occurrence, progression, and mortality of diabetic nephropathy: a systematic review and meta-analysis. Sci Rep. 2026; doi:10.1038/s41598-025-30680-4
