Prognostic value of neutrophil percentage-to-albumin, uric acid-to-creatinine, and CRP-to-albumin ratios for mortality in patients on maintenance hemodialysis.

Authors

Tahsin Karaaslan, Ozgul Akdeniz Balseven, Irem Pembegul

Published in

Jornal brasileiro de nefrologia. Volume 48. Issue 4. Pages e20260011.

Abstract

Identifying reliable biomarkers to predict mortality in hemodialysis patients is essential for risk stratification and clinical decision-making. This study evaluated the prognostic value of the serum uric acid-to-creatinine ratio (SUA/SCr), C-reactive protein-to-albumin ratio (CAR), neutrophil percentage-to-albumin ratio (NPAR), and lactate dehydrogenase (LDH).
This retrospective cohort study included 138 maintenance hemodialysis patients with at least 6 months of dialysis vintage (2017-2025). Demographic, biochemical, and hematological data were obtained from medical records. Dialysis adequacy was assessed using Kt/Vurea. Mortality predictors were analyzed using ROC curves, logistic regression, and survival analysis.
The mean age of the study population was 60.6 ± 15.1 years, and 50.7% were female. Deceased patients were significantly older than survivors (65.1 ± 16.2 vs. 58.9 ± 14.5 years; p = 0.032). The median hemodialysis vintage was 63.5 months, and 55.1% of patients used a hemodialysis catheter. Mortality was significantly higher among catheter users (p = 0.002). Deceased patients exhibited higher levels of CRP, SUA/SCr, CAR, and NPAR, along with lower albumin levels (all p < 0.001), as well as higher ferritin levels (p = 0.043). ROC analysis identified LDH ≥ 165.5, CAR ≥ 3.1, and NPAR ≥ 18.15 as optimal cut-off values associated with increased mortality risk. In multivariable analysis, CAR, NPAR, LDH, continuous SUA/SCr, and vascular access type were independent predictors of mortality. Kaplan-Meier analysis demonstrated significantly reduced survival in high-risk groups.
Elevated SUA/SCr, CAR, NPAR, and LDH levels are significantly associated with mortality in hemodialysis patients. CAR, NPAR, continuous SUA/SCr, LDH, and catheter use independently predict all-cause mortality.

PMID:
42636347
Bibliographic data and abstract were imported from PubMed on 25 Aug 2026.

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