Neutrophils are responsible for the first line of host immune response against invading pathogens, through different mechanisms, including chemotaxis, phagocytosis, release of reactive oxygen species (ROS), granular proteins and the production and liberation of cytokines. Neutrophils display different phenotypes from the time they leave the bone marrow and enter the circulation (fresh neutrophils) to the time they disappear from the circulation (aged neutrophils). This shift in phenotype is known as aging, since it takes place within a single day, and results in various neutrophils with distinct properties. Neutrophils are the first cell type recruited to sites of inflammation. From there, they can switch phenotypes and generate various subpopulations with different cell functions. Neutrophils can also interact, directly, or via cytokines and chemokines, with other immune cells to modulate both innate and adaptive immune responses. Nonmicrobial inflammation contributes to CKD progression and fibrosis. The neutrophil count reflects inflammation, while the lymphocyte count indicates the status of general stress and nutrition. The neutrophil-to-lymphocyte ratio (NLR) in CKD patients provides information on the inflammation status. Recently, neutrophil-to-lymphocyte ratio (NLR) was reported to be associated with inflammation in ESRD including both hemodialysis (HD) and peritoneal dialysis (PD) patients, and estimate survival in HD patients. Vitamin D plays a crucial role in calcium homeostasis and bone metabolism. With chronic and/or severe vitamin D deficiency, a decline in intestinal calcium and phosphorus absorption leads to hypocalcemia leading to secondary hyperparathyroidism. This secondary hyperparathyroidism then leads to phosphaturia and accelerated bone demineralization.