Recent studies have reinforced the association between high NLR and PAD in hemodialysis patients. This highlights the need for further studies to confirm its predictive value and determine optimal cut-off thresholds tailored to local patient populations. Accordingly, the present study aims to investigate the relationship between NLR and the presence of PAD in patients undergoing regular hemodialysis. By establishing this association in a well-defined population, we hope to provide evidence that supports the use of NLR as a simple, cost-effective tool for PAD risk stratification and early intervention

Inclusion Criteria:

• Adult patients aged ≥18 years.
• Undergoing maintenance hemodialysis for at least 3 months (thrice weekly)
• Able to provide informed consent.
• Willing to undergo clinical and laboratory evaluations, including peripheral vascular assesment

Exclusion Criteria:

• Active infection or sepsis at the time of evaluation

  .* Patients who have a sedimentation rate of more than 60 mm/hour

  *. Known autoimmune or hematologic disorders that may influence leukocyte count.

• Current use of immunosuppressive therapy, corticosteroids, or chemotherapy.5. History of malignancy.6. Patients with incomplete medical records or unable to undergo peripheral vascular assessment.

The present study aims to investigate the relationship between NLR and the presence of PAD in patients undergoing regular hemodialysis. By establishing this association in a well-defined population, we hope to provide evidence that supports the use of NLR as a simple, cost-effective tool for PAD risk stratification and early intervention