Iran Medical Council Journal of Iranian Medical Council 2645-338X 9 3 2026 07 01 Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio, and Systemic Immune-Inflammation Index Association with Nutritional Markers in Maintenance Hemodialysis Patients 726 735 245109 10.18502/jimc.v9i3.21833 EN Toktam Alirezaei Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-4473-7093 Farhad Esmailsorkh Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0009-0001-6001-2711 Sara Assadiasl Molecular Immunology Research Center, Tehran University of Medical Sciences, Tehran, Iran 0000-0001-5244-3127 Mohsen Aghabagheri Department of Nephrology, Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0009-0009-7529-8466 Nooshin Dalili Chronic Kidney Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Hossein Amini Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-6594-0760 Mahboobeh Freidoon Department of Nephrology, Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Journal Article 2025 04 09 <strong>Background:</strong> Cardiovascular Disease (CVD) is the leading cause of death in patients with End-Stage Renal Disease (ESRD) undergoing Hemodialysis (HD). Recent studies have demonstrated that the Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Systemic Immune-Inflammation Index (SII) may help identify individuals at high risk of CVD. Malnutrition and inflammation have also been identified as significant risk factors for CVD in HD patients.<br><strong>Methods:</strong> Eighty-nine patients undergoing maintenance hemodialysis were included in the study. Nutritional parameters—including albumin, uric acid, Blood Urea Nitrogen (BUN), creatinine, triglycerides, cholesterol, Low-Density Lipoprotein (LDL), High-Density Lipo-protein (HDL), Fasting Blood Sugar (FBS), and Hemoglobin A1c (HbA1c)—were measured. The relationship between these parameters and NLR, PLR, and SII, was analyzed.<br><strong>Results:</strong> BUN, creatinine, uric acid, ferritin, FBS, HbA1c, LDL, and triglycerides were positively correlated with PLR, NLR, and SII (p<0.05). Conversely, albumin was negatively correlated with NLR and SII; as albumin levels increased, NLR and SII decreased (p<0.05). The correlation between albumin and PLR was not statistically significant (p>0.05). HDL was significantly negatively associated with NLR, PLR, and SII. Additionally, age had a significant effect on the variation of SII, NLR, and PLR (p<0.05).<br><strong>Conclusion:</strong> The three novel inflammatory composite indices—SII, NLR, and PLR—were closely associated with common nutritional biomarkers and may serve as cost-effective and convenient markers for predicting clinical prognosis in ESRD patients with CVD risk. https://www.jimc.ir/article_245109_08692f7f50cd3096ffc45b123d14f323.pdf