Abstract
This study aimed to evaluate the association between neutrophil percentage-to-albumin ratio (NPAR) and both all-cause and cardiovascular disease (CVD) mortality in patients with chronic kidney disease (CKD). Data from 7854 CKD patients aged ≥ 20 years were analyzed using the National Health and Nutrition Examination Survey (NHANES) data from 2001 to 2018. Weighted Cox proportional hazards models, subgroup analyses, smoothed curve fitting, and Kaplan-Meier survival curves were employed to examine the association between NPAR and mortality risk. Additionally, Receiver operating characteristic (ROC) curves were used to compare NPAR's predictive performance against traditional inflammatory markers. During a median follow-up of 79 months, there were 2795 all-cause deaths and 1019 CVD deaths. A U-shaped association was identified between NPAR and all-cause mortality, with an inflection point at NPAR = 12. Below this threshold, higher NPAR was associated with lower mortality risk (HR: 0.94, 95% CI 0.90-0.99); above it, increased NPAR corresponded to higher risk (HR: 1.14, 95% CI 1.12-1.16). Additionally, NPAR exhibited a positive association with CVD mortality (HR: 1.08, 95% CI 1.04-1.12). Compared to the lowest quartile, the highest NPAR quartile demonstrated significantly increased risks of all-cause mortality (HR: 2.24, 95% CI 1.88-2.66) and CVD mortality (HR: 1.91, 95% CI 1.42-2.58). ROC curve analysis demonstrated NPAR's superior predictive capability compared to traditional inflammatory markers. NPAR exhibits significant associations with mortality outcomes in patients with CKD and surpasses traditional inflammatory markers in predicting mortality risk, highlighting its potential clinical value as a simple and cost-effective prognostic indicator.