HALP score and kidney disease progression in patients with chronic kidney disease: The Fukushima CKD Cohort Study

The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, a composite biomarker reflecting nutritional and inflammatory status, was first proposed in 2015 as a prognostic indicator for survival in patients with gastric cancer (Chen et al., Oncotarget, 2015). Since then, the HALP score has been reported to be associated with poor prognosis in various chronic diseases. However, its clinical significance in patients with chronic kidney disease (CKD) remains unclear. The present study aimed to evaluate the association between HALP score and kidney disease progression in patients with CKD not on chronic dialysis.

We analyzed 1,034 patients with CKD enrolled in the Fukushima CKD Cohort Study. Patients on maintenance dialysis at baseline were excluded. The HALP score was calculated as hemoglobin (g/L) × albumin (g/L) × lymphocyte count (/L) divided by platelet count (/L), as originally described by Chen et al. (2015). The primary endpoint was kidney events, defined as a composite of end-stage kidney disease requiring kidney replacement therapy or a ≥50% decline in estimated glomerular filtration rate (eGFR) from baseline. All-cause mortality was assessed as a secondary endpoint. Survival analyses were performed using Kaplan–Meier curves and Cox proportional hazards models adjusted for age, sex, smoking history, history of cardiovascular disease, diabetes, body mass index (BMI), systolic blood pressure, baseline eGFR, proteinuria, and use of renin–angiotensin system inhibitors.

The median age was 66 years (interquartile range [IQR], 57–75), median eGFR was 50.7 mL/min/1.73 m² (IQR, 36.5–63.3), and median HALP score was 39.7 (IQR, 27.1–54.7). Males accounted for 57.0% of the cohort, diabetes was present in 47.7%, and 12.3% had a history of cardiovascular disease. Patients were stratified into tertiles according to the HALP score. Age did not differ significantly among groups, but patients in the lower tertiles had significantly lower BMI and eGFR and a higher proportion of females. During a median follow-up of 5.3 years, 177 kidney events and 112 deaths occurred. Kaplan–Meier analysis revealed significantly higher risks of kidney events (P < 0.001) and all-cause mortality (P = 0.004) in the lower HALP tertiles compared with higher tertiles. In multivariable Cox models, the lowest tertile (T1) showed a significantly increased risk of kidney events compared with the highest tertile (T3) (hazard ratio [HR] 2.98, 95% confidence interval [CI] 1.99-4.46), and this association remained significant after adjustment for confounders (adjusted HR 2.05, 95% CI 1.32-3.20). A similar trend was observed for all-cause mortality, with significantly elevated risk in the lowest tertile (adjusted HR 1.75, 95% CI 1.06-2.90).

A low HALP score was significantly associated with an increased risk of kidney disease progression and all-cause mortality in patients with CKD. Our findings highlight the clinical importance of integrating nutritional and inflammatory status into risk stratification for CKD patients. Incorporating the HALP score into routine clinical assessment may help identify high-risk individuals who could benefit from early interventions to slow disease progression.