Department of Nephrology, Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Department of Health Management, Health Management Center, General Practice Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
PLoS One. 2024 Aug 5;19(8):e0307466. doi: 10.1371/journal.pone.0307466. eCollection 2024.
The neutrophil-percentage-to-albumin ratio (NPAR), a novel inflammatory biomarker, has been used to predict the prognosis of patients with cancer and cardiovascular disease. However, the relationship between NPAR and chronic kidney disease (CKD) remains unknown. The purpose of this study was to investigate the possible association between NPAR and CKD.
The cross-sectional study included participants with complete information on NPAR, serum creatinine (Scr), or urinary albumin-to-creatinine ratio (UACR) from the 2009-2018 National Health and Nutrition Examination Survey (NHANES). CKD was defined as the presence of either low estimated glomerular filtration rate (eGFR) or albuminuria. Univariate and multivariate logistic regression and restricted cubic spline regression were used to assess the linear and nonlinear associations between NPAR and renal function. Subgroup and interactive analyses were performed to explore potential interactive effects of covariates. Missing values were imputed using random forest.
A total of 25,236 participants were enrolled in the study, of whom 4518 (17.9%) were diagnosed with CKD. After adjustment for covariates, the odds ratios (ORs) for prevalent CKD were 1.19 (95% CI = 1.07-1.31, p <0.05) for the Q2 group, 1.53 (95% CI = 1.39-1.69, p < 0.001) for the Q3 group, and 2.78 (95% CI = 2.53-3.05, p < 0.001) for the Q4 group. There was a significant interaction between age and diabetes mellitus on the association between NPAR and CKD (both p for interaction < 0.05). And there was a non-linear association between NPAR levels and CKD in the whole population (p for non-linear < 0.001). All sensitivity analyses supported the positive association between NPAR and CKD.
NPAR was positively correlated with increased risk of CKD. The NPAR may serve as an available and cost-effective tool for identifying and intervening the individuals at risk of CKD.
中性粒细胞与白蛋白比值（NPAR）是一种新的炎症生物标志物，已被用于预测癌症和心血管疾病患者的预后。然而，NPAR 与慢性肾脏病（CKD）之间的关系尚不清楚。本研究旨在探讨 NPAR 与 CKD 之间可能存在的关联。
这项横断面研究纳入了 2009-2018 年全国健康与营养调查（NHANES）中具有完整 NPAR、血清肌酐（Scr）或尿白蛋白/肌酐比值（UACR）信息的参与者。CKD 的定义为估算肾小球滤过率（eGFR）降低或存在蛋白尿。采用单变量和多变量逻辑回归以及限制立方样条回归来评估 NPAR 与肾功能之间的线性和非线性关联。进行亚组和交互分析以探讨协变量的潜在交互作用。使用随机森林法对缺失值进行插补。
共纳入 25236 名参与者，其中 4518 名（17.9%）患有 CKD。在调整了协变量后，第 2 四分位组、第 3 四分位组和第 4 四分位组发生 CKD 的优势比（OR）分别为 1.19（95%CI=1.07-1.31，p<0.05）、1.53（95%CI=1.39-1.69，p<0.001）和 2.78（95%CI=2.53-3.05，p<0.001）。NPAR 与 CKD 之间的关联在年龄和糖尿病之间存在显著的交互作用（两者 p 值交互<0.05）。在整个人群中，NPAR 水平与 CKD 之间存在非线性关联（p 值非线性<0.001）。所有敏感性分析均支持 NPAR 与 CKD 之间的正相关关系。
NPAR 与 CKD 风险的增加呈正相关。NPAR 可能是一种可用且具有成本效益的工具，可用于识别和干预 CKD 高危人群。
