Monocyte lymphocyte ratio, IL 6, and their association with increased carotid intima-media thickness as simple predictive markers for nephropathy in Egyptian diabetic patients

Inflammation is a cardinal mechanism of diabetic kidney disease (DKD). Interleukin-6 (IL6) is a reliable indicator that plays a role in the progression of DKD. Monocyte-to-lymphocyte ratio (MLR) is also implicated in this inflammatory process. The progression of DKD is associated with increased carotid intima-media thickness (CIMT), which is an independent predictor of atherosclerosis.

The role of IL6 and MLR ratio influencing the progression of DKD was assessed using the urinary albumin creatinine ratio (UACR) and glomerular filtration rate (GFR). Moreover, their contribution to increasing CIMT in DKD was assessed.

An observational prospective study was conducted on ninety diabetic patients presented to the Internal Medicine Clinic at Kasr AlAiny. The subjects were classified into three groups, thirty patients for each, according to UACR: with normoalbuminuria, microalbuminuria, and macroalbuminuria. A history and clinical assessment, CBC, MLR, HbA1c, lipid profile, IL6, creatinine, and eGFR were carried out. Furthermore, CIMT was measured using Doppler ultrasound.

The results showed that IL6 and MLR were significantly higher in the macroalbuminuria group compared to the other two groups with p < 0.001, suggesting that their higher level could predict the progression of DKD. According to the ROC curve, the cutoff values of MLR and IL6 were 0.3425 and 7 pg/ml, respectively. Moreover, CIMT increased significantly in micro and macroalbuminuric patients with p > 0.001. IL6 and MLR were positively correlated with CIMT in micro and macroalbuminuric patients.

Both MLR and IL-6, as simple biomarkers associated with increased CIMT, play an important role in predicting the nephropathy of DKD patients.