Relationship between neutrophil percentage to albumin ratio and cardiovascular disease mortality in chronic kidney disease patients; a systematic review and meta-analysis

Introduction: Chronic inflammation plays a significant role in cardiovascular disease (CVD)–related mortality among patients with chronic kidney disease (CKD). The neutrophil‑to‑albumin percentage ratio (NPAR) has emerged as an indicator of an individual’s inflammatory status. This study aimed to investigate the association between elevated NPAR and the risk of CVD mortality in patients with CKD. Materials and Methods: The study was conducted in accordance with the PRISMA reporting guidelines. Comprehensive searches were performed across the Cochrane Library, Scopus, Web of Science, Embase, and PubMed databases, as well as the Google Scholar search engine, up to 30 January 2026. All statistical analyses were carried out using STATA version 14. Results: Compared with lower NPAR values, elevated NPAR was associated with a higher risk of cardiovascular mortality (OR = 1.54; 95% CI: 1.33–1.78) and all‑cause mortality (OR = 1.62; 95% CI: 1.40–1.89) in patients with CKD. In addition, higher NPAR increased the risk of CVD‑related death among patients undergoing hemodialysis (OR = 1.66; 95% CI: 1.29–2.15) and peritoneal dialysis (OR = 1.56; 95% CI: 1.25–1.94). Furthermore, the third quartile of NPAR (OR = 1.44; 95% CI: 1.16–1.78), the fourth quartile (OR = 1.92; 95% CI: 1.61–2.30), the second tertile (OR = 1.38; 95% CI: 1.07–1.80), and the third tertile (OR = 1.97; 95% CI: 1.61–2.41) were all associated with increased CVD mortality compared with the lowest category. Elevated NPAR also increased the risk of CVD‑related mortality in both men (OR = 1.23; 95% CI: 1.04–1.45) and women (OR = 1.16; 95% CI: 1.08–1.24) with CKD. Conclusion: Higher NPAR levels were associated with an increased likelihood of cardiovascular and all‑cause mortality among individuals with CKD. As NPAR values rose, the risk of CVD‑related death increased correspondingly when compared with lower levels. In addition, cardiovascular mortality risk was greater in men than in women, and higher among patients receiving hemodialysis than those undergoing peritoneal dialysis. Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO (ID: CRD420261304086) and Research Registry (UIN: reviewregistry2082) websites.