The prognostic value of the neutrophil-percentage-to-albumin ratio for all-cause and cardiovascular mortality in chronic kidney disease stages G3a to G5: insights from NHANES 2003–2018

BACKGROUND: Patients with chronic kidney disease (CKD) stages G3a to G5 frequently experience heightened systemic inflammation and nutritional loss. Identifying laboratory-accessible, cost-effective markers that can effectively predict the prognosis of CKD stages G3a to G5 is crucial. METHODS: This prospective cohort study included 3,331 patients with CKD stages G3a to G5 who participated in the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2018. Multivariable adjusted Cox proportional hazards regression models and restricted cubic spline analyses were used to assess the associations of neutrophil percentage-to-albumin ratio (NPAR) levels with all-cause mortality, CVD, and non-CVD mortality. RESULTS: The cohort study encompassed data from 3,331 participants for analysis. Nonlinear J-shaped associations were observed between NPAR levels and the risk of all-cause, CVD, and non-CVD mortality in patients with CKD stages G3a to G5. High levels NPAR exhibited a significantly elevated risk of both all-cause and CVD mortality in the fully adjusted model. The respective hazard ratios (HRs) for all-cause mortality were 1.23 [95% confidence interval (CI), 1.05-1.44], and for CVD mortality, 1.513 (95% CI, 1.131-2.024). CONCLUSIONS: Elevated NPAR can predict both all-cause and CVD deaths in advanced CKD patients. Individuals with high NPAR levels face an elevated risk of mortality and exhibit a decreased survival rate in the context of CKD. This finding offers evidence supporting the timely evaluation and intervention for inflammation and nutritional status in individuals with CKD stages G3a to G5.