Mohammad Rostamzadeh
1 
, Yaser Abolhasani
2 , Amir Heidari
3 , Abdolmohammad Ranjbar
1 , Ali Emadzadeh
4 , Maede Safari
5 , Niloofar Khosravi
6 , Samaneh Zandifar
7 , Roozbeh Roohinezhad
8 , Mohamadnavid Vanda
9 , Reza Faramarzzadeh
10* 1 Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
2 Department of Operating Room Technology, School of Paramedical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
3 Department of Cardiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Department of Internal Medicine, MMS.C., Islamic Azad University, Mashhad, Iran
5 Urology Department, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
6 Anesthesiology Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
7 Guissu Research Corporation, Bandar Abbas, Iran
8 Department of Urology, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
9 Department of General Surgery, School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
10 Department of Cardiology, Seyed-al-shohada Cardiology Hospital, Urmia University of Medical Science, Urmia, Iran
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.