Relationship Between Neutrophil Percentage to Albumin Ratio and Cardiovascular Disease Mortality in Chronic Kidney Disease Patients; a Systematic Review and Meta-Analysis Publisher

Summary: Can a blood inflammation ratio signal heart risk in kidney disease? A meta-analysis linked higher NPAR with greater cardiovascular and overall mortality, not causation. #KidneyDisease #Cardiology

Rostamzadeh M ; Abolhasani Y ; Heidari A ; Ranjbar A ; Emadzadeh A ; Safari M ; Khosravi N ; Zandifar S ; Roohinezhad R ; Vanda M ; Faramarzzadeh R
Source: Journal of Nephropathology Published:2026

Abstract

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. Implication for health policy/practice/research/medical education: In this meta-analysis study, we found that higher neutrophil-to-albumin percentage ratio (NPAR) values signaled a greater probability of both cardiovascular and overall mortality in patients with chronic kidney disease (CKD). As the NPAR increased, the likelihood of cardiovascular disease (CVD)–related death compared with patients who had lower NPAR. The data also point to important subgroup differences; men faced a higher cardiovascular mortality risk than women, and individuals on hemodialysis showed a greater vulnerability than those treated with peritoneal dialysis. In clinical settings, elevated NPAR may serve as a useful signal for identifying CKD patients at heightened risk of both cardiovascular and overall mortality. Please cite this paper as: Rostamzadeh M, Abolhasani Y, Heidari A, Ranjbar A, Emadzadeh A, Safari M, Khosravi N, Zandifar S, Roohinezhad R, Vanda M, Faramarzzadeh R. Relationship between neutrophil percentage to albumin ratio and cardiovascular disease mortality in chronic kidney disease patients; a systematic review and meta-analysis. J Nephropathol. 2026;15(3):e28709. DOI: 10.34172/jnp.2026.28709. Copyright © 2026 The Author(s); Published by Society of Diabetic Nephropathy Prevention. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.