Neutrophil-to-lymphocyte ratio Linked to Poor Outcomes in CKD and MACE: Study

A new study published in the journal of BMC Nephrology showed that neutrophil-to-lymphocyte ratio (NLR) shows a significant association with all-cause mortality, major adverse cardiovascular events (MACE), cardiovascular mortality, and adverse renal outcomes in chronic kidney disease (CKD).

About 10% of people worldwide suffer from chronic kidney disease (CKD), a progressive illness linked to higher rates of morbidity and death, especially from cardiovascular events and end-stage renal disease (ESRD). According to studies, advanced chronic kidney disease (CKD) frequently exhibits a microinflammatory state, which is linked to consequences such anemia, vascular calcification, cardiovascular events, and all-cause mortality.

One indicator of systemic inflammation and immunological dysregulation that has shown promise as a predictive tool is the neutrophil-to-lymphocyte ratio (NLR). A pro-inflammatory state linked to endothelial dysfunction and oxidative stress is reflected in elevated NLR. The predictive significance of NLR for all-cause mortality, MACE, and progression to ESRD or dialysis in CKD is reevaluated in this meta-analysis, which also updates the data base through 2025.

Up until March 8, 2025, PubMed, Web of Science, Embase, and the Cochrane Library were searched for pertinent material. This research assessed cardiovascular death, major adverse cardiovascular events (MACE), all-cause mortality, and progression to dialysis or end-stage renal disease (ESRD). The 95% CI and odds ratios (OR) were employed to estimate the impact.

There were 36 trials with 26,074 subjects. High NLR was found to be significantly linked to a higher risk of cardiovascular mortality (OR = 1.21, 95% CI: 1.09–1.35; p = 0.0004), MACE (OR = 1.42, 95% CI: 1.14–1.77; p = 0.002), all-cause mortality (OR = 1.22, 95% CI: 1.15–1.29; p < 0.00001), and ESRD (OR = 1.68, 95% CI: 1.17–2.43; p = 0.005), according to the meta-analysis.

The patients who died from cardiovascular causes (SMD = 1.44, 95% CI: 0.77–2.11; p < 0.0001) and all causes (SMD = 0.84, 95% CI: 0.58–1.11; p < 0.00001) had significantly higher NLR levels than survivors. The robustness of the findings was confirmed by sensitivity and subgroup analysis. In the GRADE system, every indication received an extremely low rating.

Overall, these results show that NLR is substantially linked to cardiovascular mortality, MACE incidence, all-cause mortality, and poor renal outcomes in CKD. Despite stable results, high heterogeneity and publication bias limit clinical applicability. Therefore further large-scale prospective studies are needed to validate NLR as a prognostic marker in CKD.

Source:

Xu, Y., Chen, Y., Mai, X., & Zhang, M. (2025). Prognostic value of neutrophil-to-lymphocyte ratio for the clinical outcomes of chronic kidney diseases: an update systematic review and meta-analysis. BMC Nephrology, 26(1), 419. https://doi.org/10.1186/s12882-025-04363-1