Association between systemic immune-inflammation index and risk of chronic kidney disease; a systematic review and meta-analysis

Sayed Yousef Mojtahedi; Reza Tavakolizadeh; Mohsen Jafari; Hosein Shabani-Mirzaee; Maede Safari; Maryam Ghodsi; Masoumeh Ghasempour Alamdari; Niloufar Ghanbari; Paniz Pourpashang

doi:10.34172/jnp.2025.27613

J Nephropathol. 2025;14(2): e27613.
doi: 10.34172/jnp.2025.27613

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Meta-analysis

Association between systemic immune-inflammation index and risk of chronic kidney disease; a systematic review and meta-analysis

Sayed Yousef Mojtahedi ^1,2 , Reza Tavakolizadeh ³ , Mohsen Jafari ⁴, Hosein Shabani-Mirzaee ⁵ , Maede Safari ⁶ , Maryam Ghodsi ⁷ , Masoumeh Ghasempour Alamdari ⁸ , Niloufar Ghanbari ⁹ , Paniz Pourpashang ^1,2^*

¹ Pediatric Chronic Kidney Disease Research Center, Gene, Cell and Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
² Department of Pediatric Nephrology, Bahrami Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
³ Department of Pediatrics, Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
⁴ Department of Pediatric Infectious Diseases, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
⁵ Department of Pediatric Endocrinology, Bahrami Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
⁶ Urology Department, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
⁷ Department of Pediatric Intensive Care, School of Medicine, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran
⁸ Department of Pediatric Pulmonology, Tehran University of Medical Sciences, Bahrami Hospital, School of Medicine, Tehran, Iran
⁹ Emergency Division, Bahrami Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

*Corresponding Author: Paniz Pourpashang, Email: paaniz.p@gmail.com

Abstract

Introduction: Inflammation is a hallmark feature of chronic kidney disease (CKD) and the systemic immune-inflammation index (SII) is a potent biomarker for assessing the inflammatory status. Taking note of these, the present systematic review and meta-analysis evaluated the correlation between SII and the risk for CKD.

Materials and Methods: ProQuest, Embase, PubMed, Web of Science, Cochrane, and Google Scholar databases were searched until November 20, 2024, without any restriction applied. Data were analyzed in Stata v14.0. The results with P<0.05 were considered to be statistically significant.

Results: Elevated SII values enhanced the overall risk of CKD (OR: 1.24; 95% CI: 1.52, 1.267), CKD risk in females (OR: 1.03; 95% CI: 1, 1.07), and CKD risk in the USA (OR: 1.27; 95% CI: 1.16, 1.38). Contrarily, no significant correlation was observed between SII and the risk for CKD among males (OR: 1.03; 95% CI: 0.99, 1.07) and in China (OR: 1.15; 95% CI: 0.98, 1.34). The second tertile (OR: 1.14; 95% CI: 1.05, 1.25), third tertile (OR: 1.49; 95% CI: 1.28, 1.73), third quartile (OR: 1.16; 95% CI: 1.08, 1.24), and fourth quartile (OR: 1.42; 95% CI: 1.27, 1.59) of the SII index enhanced the risk of CKD. Elevated SII values (OR: 1.43; 95% CI: 1.20, 1.70) enhanced the risk for CKD. Likewise, high SII values enhanced the risk for CKD in patients with diabetes mellitus (DM) (OR: 1.42; 95% CI: 1.21, 1.68), low-estimated glomerular filtration rate (eGFR) (OR: 1.27; 95% CI: 1.14, 1.40), and albuminuria (OR: 1.46; 95% CI: 1.08, 1.97), as well as in patients with BMI>30 kg/m² (OR: 1.05; 95% CI: 1.01, 1.09).

Conclusion: Elevated SII values enhanced the risk of CKD, and the SII-CKD association was intensified in females, Americans, and patients with DM, low eGFR, albuminuria, and obesity. Accordingly, high SII levels are a robust indicator of CKD prognosis.

Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO (ID: CRD42024619311) and Research Registry (UIN: reviewregistry1925, ) websites.

Keywords: Systemic immune-inflammation, SII index, Chronic renal disease, Chronic kidney disease, Renal insufficiency

Implication for health policy/practice/research/medical education:

The findings indicate that elevated systemic immune-inflammation index (SII) values significantly increase the risk of chronic kidney disease (CKD), particularly among specific populations such as females, Americans, and individuals with diabetes mellitus, low-estimated glomerular filtration rate (eGFR), albuminuria, and obesity, underscore critical implications for health policy, practice, research, and medical education. Health policies should prioritize the integration of SII monitoring into routine clinical assessments to identify at-risk populations early, facilitating timely interventions. In clinical practice, healthcare providers should be trained to recognize the importance of SII as a prognostic marker for CKD, enabling tailored management strategies for patients exhibiting high SII levels. Furthermore, research initiatives should focus on elucidating the underlying mechanisms linking inflammation to CKD progression while exploring potential therapeutic targets. Finally, medical education curricula must incorporate the significance of inflammatory markers like SII in chronic disease management to prepare future healthcare professionals for evidence-based practice in nephrology and related fields.

Please cite this paper as: Mojtahedi SY, Tavakolizadeh R, Jafari M, Shabani-Mirzaee H, Safari M, Ghodsi M, Ghasempour Alamdari M, Ghanbari N, Pourpashang P. Association between systemic immune-inflammation index and risk of chronic kidney disease; a systematic review and meta-analysis. J Nephropathol. 2025;14(2):e27613. DOI: 10.34172/jnp.2025.27613.