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Association of Neutrophil Percentage-To-Albumin Ratio With All-Cause and Cardiovascular Mortality in Chronic Kidney

Yingying Wu1, Siqi Ding1

  • 1The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu Central Hospital, Yiwu, Zhejiang, China.

Inquiry : a Journal of Medical Care Organization, Provision and Financing
|May 10, 2026
PubMed

Insights

Higher neutrophil percentage-to-albumin ratio (NPAR) significantly increases cardiovascular disease (CVD) and all-cause mortality risk in chronic kidney disease (CKD) patients. NPAR shows potential as a prognostic biomarker for these high-risk populations.

Area of Science:

  • Biomarkers and Prognostics
  • Nephrology
  • Cardiovascular Disease Epidemiology

Background:

  • Chronic kidney disease (CKD) is associated with increased cardiovascular disease (CVD) and all-cause mortality.
  • Identifying reliable prognostic biomarkers for mortality risk in CKD patients is crucial for clinical management.

Purpose of the Study:

  • To investigate the relationship between the neutrophil percentage-to-albumin ratio (NPAR) and mortality from CVD and all causes in patients with CKD.
  • To evaluate NPAR as a potential prognostic biomarker for mortality in the CKD population.

Main Methods:

  • Survival analysis using Kaplan-Meier curves and multivariate Cox proportional hazards models in 7,553 CKD patients.
  • Restricted cubic spline (RCS) analysis for non-linear associations and receiver operating characteristic (ROC) analysis for predictive performance.
  • Subgroup analyses were performed based on demographic characteristics.

Main Results:

  • Higher NPAR was significantly associated with increased CVD and all-cause mortality (p < 0.0001).
  • A one-unit increase in NPAR correlated with a 185% higher risk of CVD mortality (HR = 2.85) and a 154% higher risk of all-cause mortality (HR = 2.54).
  • NPAR demonstrated modest discriminative ability for all-cause mortality (AUC = 0.601) with an optimal cutoff of 1.48.

Conclusions:

  • Elevated NPAR is linked to a higher likelihood of CVD and all-cause mortality in patients with CKD.
  • NPAR may serve as an effective and independent prognostic biomarker for predicting mortality in CKD patients.

Keywords:
CVD mortalitychronic kidney diseasemortalitynational health and nutrition examination surveyneutrophil percentage-to-albumin ratio

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