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Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：中性粒细胞与白蛋白的百分比（NPAR），一种新的炎症生物标志物，已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)的关系尚不清楚.本研究的目的是探讨NPAR与CKD之间可能的关联。
方法：横断面研究包括具有完整NPAR信息的参与者，血清肌酐(Scr),或尿白蛋白肌酐比（UACR）来自2009-2018年全国健康和营养检查调查（NHANES）。CKD定义为存在低估计肾小球滤过率(eGFR)或蛋白尿。使用单变量和多变量逻辑回归以及限制性三次样条回归来评估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索协变量的潜在交互效应。使用随机森林估算缺少的值。
结果：共有25,236名参与者参加了这项研究，其中4518人（17.9%）被诊断为CKD。在调整协变量后，Q2组普遍CKD的比值比（ORs）为1.19（95％CI=1.07-1.31，p<0.05），Q3组1.53(95%CI=1.39-1.69，p<0.001)，和2.78（95%CI=2.53-3.05，p<0.001）为Q4组。在NPAR和CKD之间的关联上,年龄和糖尿病之间存在显著的交互作用(均p表示交互作用<0.05)。在整个人群中，NPAR水平与CKD之间存在非线性关联（非线性p<0.001）。所有敏感性分析均支持NPAR与CKD呈正相关。
结论：NPAR与CKD风险增加呈正相关。NPAR可以作为用于识别和干预处于CKD风险的个体的可用且具有成本效益的工具。
方法：横断面研究包括具有完整NPAR信息的参与者，血清肌酐(Scr),或尿白蛋白肌酐比（UACR）来自2009-2018年全国健康和营养检查调查（NHANES）。CKD定义为存在低估计肾小球滤过率(eGFR)或蛋白尿。使用单变量和多变量逻辑回归以及限制性三次样条回归来评估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索协变量的潜在交互效应。使用随机森林估算缺少的值。
结果：共有25,236名参与者参加了这项研究，其中4518人（17.9%）被诊断为CKD。在调整协变量后，Q2组普遍CKD的比值比（ORs）为1.19（95％CI=1.07-1.31，p<0.05），Q3组1.53(95%CI=1.39-1.69，p<0.001)，和2.78（95%CI=2.53-3.05，p<0.001）为Q4组。在NPAR和CKD之间的关联上,年龄和糖尿病之间存在显著的交互作用(均p表示交互作用<0.05)。在整个人群中，NPAR水平与CKD之间存在非线性关联（非线性p<0.001）。所有敏感性分析均支持NPAR与CKD呈正相关。
结论：NPAR与CKD风险增加呈正相关。NPAR可以作为用于识别和干预处于CKD风险的个体的可用且具有成本效益的工具。
