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

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OBJECTIVE: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.

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