A Routine Blood Ratio that predicts Survival in Older Adults with Chronic Kidney Disease

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A Routine Blood Ratio that predicts Survival in Older Adults with Chronic Kidney Disease

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Co-author 1

Guido Gembillo guidogembillo@live.it Unit of Nephrology and Dialysis Department of Clinical and Experimental Medicine, University of Messina Messina Italy *

Co-author 2

Luca Soraci l.soraci@inrca.it Unit of Geriatric Medicine talian National Research Center on Aging (IRCCS INRCA) Cosenza Italy -

Co-author 3

Andrea Corsonello a.corsonello@inrca.it Unit of Geriatric Medicine talian National Research Center on Aging (IRCCS INRCA) Cosenza Italy -

Co-author 4

Domenico Santoro dsantoro@unime.it Unit of Nephrology and Dialysis Department of Clinical and Experimental Medicine, University of Messina Messina Italy -

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Introduction

Can a simple blood test ratio predict survival in older adults with chronic kidney disease? We investigated whether the monocyte-to-HDL ratio (MHR), a readily available inflammatory marker, forecasts mortality risk in this vulnerable population.

Methods

We analyzed two decades of NHANES data (1999-2018), tracking 5,073 individuals aged 70+ with CKD (eGFR < 60 ml/min/1.73 m² and/or ACR > 30 mg/g). MHR was calculated by dividing monocyte count by HDL cholesterol, both standard lab values. Using multivariable survey-weighted Cox and Fine & Gray competing risk models, we examined how MHR relates to death from any cause and kidney-specific mortality. We validated our findings through LASSO regression and Boruta algorithm feature selection.

Results

Over 82 months of follow-up, we documented all-cause and renal mortality rates of 72.25 (95%CI: 69.03-75.46) and 1.6 (1.11-2.09) per 1,000 person-years. The findings were striking: elevated MHR independently predicted 31% higher all-cause mortality risk (HR 1.31, 95%CI 1.19–1.44) and 33% higher kidney-specific mortality risk (sdHR 1.33, 95%CI 1.02–1.73), even after adjusting for eGFR, ACR, and key clinical factors. Feature selection confirmed MHR ranks among the top predictors of renal death, alongside eGFR and ACR.

Conclusion

MHR emerges as a powerful, independent mortality predictor in older CKD patients, offering prognostic value beyond traditional kidney markers. Because it requires no special testing, just routine bloodwork, MHR represents a practical, cost-effective tool for sharpening risk assessment in aging populations with kidney disease.

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