Evaluation of HALP Score as an Immunonutritional Marker Across CKD Stages

Abstract Background: Chronic Kidney Disease (CKD) being a long-standing condition that alters various metabolic pathways and is typically associated with nutritional deterioration and prolonged inflammatory response. Malnutrition can be caused by reduced appetite, metabolic acidosis or protein energy loss. The main causes of inflammation are accumulation of uremic toxins and presence of additional comorbidities. Both inflammation and starvation lead to immunosuppression, which raises the risk of infection and mortality. As a result, it is necessary to monitor CKD patients' inflammatory and nutritional conditions. The Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) score is a simple, straightforward, comprehensive, and affordable indicator of both nutritional and inflammatory health. Studies indicates that the advanced stages of CKD had poorer HALP scores. Evaluating and assessing HALP score across the stages of CKD facilitates assessment of patient status and directing therapies. Objectives: To evaluate HALP scores across different stages of CKD. To determine the correlation between HALP scores and eGFR at various stages of CKD. Methodology: A total of 150 people with CKD who were at least 18 years old participated in this cross-sectional study. Depending on the CKD stage, the participants were grouped into three categories: Group 1 (Stage 1), Group 2 (Stages 2 and 3), and Group 3 (Stages 4 and 5). Serum albumin levels and a complete blood count were assessed. To determine the HALP score, HALP = [Hemoglobin (g/L) × Albumin (g/L) × Lymphocyte count (/L)] ÷ Platelet count (/L) formula was used. CKD-EPI 2021 equation was used to calculate the estimated glomerular filtration rate (eGFR). Data was expressed as Mean and SD. SPSS version 29.0 was used to analyse the data. The three groups' variables were compared using a one-way ANOVA with statistical significance set at p < 0.05. The association between eGFR and other variables were assessed using Pearson's correlation, where p < 0.05 was considered statistically significant. Results: Hemoglobin (Hb), serum albumin (Alb), lymphocyte count, platelet count, HALP score, and eGFR levels varied significantly among the three study groups (p < 0.05 for all parameters). As the phases of CKD progressed, the mean HALP score decreased: Group 1 (52.52 ± 27.58), Group 2 (46.54 ± 17.74), and Group 3 (30.37 ± 19.15). There were significant differences between Groups 1 and 3. With all pairwise comparisons demonstrating statistical significance (p < 0.00001), eGFR demonstrated a significant drop across stages (Group 1: 103.02 ± 12.34; Group 2: 73.1 ± 12.62; Group 3: 9.22 ± 4.55). Significant differences between early and advanced stages of CKD were shown by post hoc analysis (Tukey HSD), particularly between Group 3 and the others. Conclusion: As the CKD stages advances, the HALP score decreases drastically, indicating a decline in immunonutritional condition. Hence, HALP score could be utilised as a straightforward, composite, and affordable marker assessing the CKD patients as it holds potential for early risk assessment, monitoring and guided nutritional and therapeutic interventions.