الفهرس 
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Abstract
Case-control study of 60 non-dialyzed CKD patients and 30 healthy volunteers as controls matched to the patients, all patients included in this study are : above 18 years old, attended outpatient department of Ain shams university hospitals diagnosed as CKD staging from 3 to 5 according to MDRD equation, and not on maintenance HD, patient who had fever or clinical evidence of infection or major surgery during last 3moths, advanced liver disease, decompensated heart diseases, chronic lung disease, malignancy, and had intestinal malabsorption syndrome were excluded from the study .
GFR was calculated by modification of diet in renal disease (MDRD)) equation: eGFR (mL/min/1.73 m2) = 30.849 × (Scr)-1.154 × (Age)-0.203 × (0.742 if female) × (1.212 if black) and the total staging is done according to KDOQI and KDIGO 2012 containing GFR and albuminuria categories.
Detailed medical history was taken including duration and cause of CKD, presence of other co-morbidities and drug history, full clinical examination including BP measurement and nutritional status assessment including protein & energy intake, BMI, MAC, TSF, MAMC, using of m-SGA and laboratory measurements including ( CBD, DLC, BUN, creatinine, P, K, Na, T. Ca, PTH, T.cholesterol,TG, s. albumin,transferrin, ferritin, TIBC, hs-CRP and ACR)
NLR calculated by dividing neutrophil count to lymphocyte count and PLR by dividing platelet count to lymphocyte count .
In this study we aimed to investigate the clinical value of NLR and PLR as inflammatory markers in evaluation of malnutrition in non- dialyzed CKD patients .
The most important study results are ; significantly higher NLR with Mean (2.83±2.76) in patients group compared to healthy subject (P<0.001). Higher PLR in patients group with Mean (144.6±63.17) than that for healthy subjects (130.2±49.11) BUT with no statistically significance (P>0.05), Mean of hs-CRP among patient group was (8195.0 ± 11946.6) ng/ml significantly higher than healthy subject (P<0.01). Mean of m-SGA was (3.60±1.39) which significantly higher in patient group than healthy subject (p<0.001) (71.7% having severe malnutrition and 28.3% moderate malnutrition), Mean of BMI (30.48 ± 5.78) higher in patients than healthy subjects with p <0.001. (11.66 % normal, 40% overweight and 48.33% obese mean of MAC (31.61 ± 7.22) & MAMC (26.84 ± 6.05) which higher in patients than controls with no difference regarding TSF, mean of protein intake (0.78 ± 0.24) significantly lower in patients than healthy subjects and no difference regarding energy intake. According to laboratory data mean of ACR (490.5 ± 617.9), K (4.74 ± 0.61 ), P (4.44 ± 1.07), PTH (169.5 ± 189.9 ), T. cholesterol (160.7 ± 102.9) and TG (160.7 ± 102.9) which higher in patients than healthy subjects, p ≤ 0.05 . while Mean of HB (11.67 ± 1.91), serum albumin (3.71 ± 0.56 ) are lower in patients compared to healthy subjects . no significant differences regarding ferritin, transferrin and TIBC . p ≤ 0.05
NLR positively correlated to hs-CRP, BMI & MAMC p≤0.005 in patients group, NLR had no correlation to m-SGA, other anthropometric measurements and laboratory parameters .
PLR positively correlated to hs-CRP, p≤0.005 in patients group, had no correlation with m-SGA, other laboratory and anthropometric parameters.
A significant positive correlation between m-SGA score with (ACR, BUN, serum creatinine, phosphorus ) and significantly negatively correlated with (serum albumin, HB,and calcium (P<0.01) and no significant correlation between m-SGA score and NLR, PLR or hs-CRP among patients group.
Conclusions:
NLR and PLR can be utilized clinically as inflammatory markers in non-dialysis CKD patients with malnutrition.
Recommendations:
1. Further cohort study is needed for assessment the clinical values of NLR and PLR as a prognostic factors in evaluation of nutritional status in CKD patients after nutritional intervention .
2. further studies are needed for further accurate tools in assessment of obesity and malnutrition in CKD .
3. Further interventional studies are needed to control malnutrition and inflammation in CKD patients.