Meta-Analysis
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Dec 20, 2025; 15(4): 107468
Published online Dec 20, 2025. doi: 10.5662/wjm.v15.i4.107468
Association of neutrophil-lymphocyte ratio with cardiovascular and all-cause mortality in patients receiving chronic hemodialysis: Systematic review and meta-analysis
Roopeessh Vempati, Nanush Damarlapally, Srivatsa Surya Vasudevan, Viral Patel, Prathibha Banda, Denise Mourad, Harshavardhan Polamarasetty, Gaurav Mathur, Afrasayab Khan, Rupak Desai, Iqbal Ratnani, Salim Surani
Roopeessh Vempati, Internal Medicine, Trinity Health Oakland Hospital, Pontiac, MI 48341, United States
Nanush Damarlapally, Health Sciences, Houston Community College-Coleman Campus, Houston, TX 77030, United States
Srivatsa Surya Vasudevan, Department of Otolaryngology, Louisiana State University Health Sciences Center, Shreveport, LA 70112, United States
Viral Patel, Internal Medicine, Baptist Hospital of South Texas, Beaumont, TX 77701, United States
Prathibha Banda, Internal Medicine, Gandhi Medical College and Hospital, Secunderabad 500003, Telangāna, India
Denise Mourad, Afrasayab Khan, Internal Medicine, Central Michigan University, Saginaw, MI 48602, United States
Harshavardhan Polamarasetty, Biomedical Engineering, University of Houston, Houston, TX 77004, United States
Gaurav Mathur, Department of Internal Medicine, Connecticut Institute for Communities, Danbury, CT 06810, United States
Rupak Desai, Outcomes Research, Independent Researcher, Atlanta, GA 30079, United States
Iqbal Ratnani, Department of Anesthesiology, Houston Methodist, Houston, TX 77030, United States
Salim Surani, Department of Medicine and Pharmacology, Texas A&M University, College Station, TX 77843, United States
Salim Surani, Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Desai R conceptualized and designed the study, developed the methodology and software, performed formal analysis, provided resources, participated in writing and editing the manuscript, and managed project administration; Surani S and Ratnani I conducted formal analysis, provided resources, reviewed and edited the manuscript, and managed project administration; Vempati R and Patel V contributed to methodology, performed screening and feasibility assessments, conducted data curation and data extraction, drafted the original manuscript, reviewed and edited the manuscript, and supervised the project; Damarlapally N participated in screening and feasibility assessments, performed data extraction, and contributed to writing the original draft and reviewing and editing the manuscript; Vasudevan SS performed statistical analysis and contributed to writing the original draft and reviewing and editing the manuscript; Banda P contributed to data extraction, writing the original draft, and reviewing and editing the manuscript; Mourad D and Polamarasetty H participated in data extraction and manuscript review and editing; Mathur G and Khan A contributed to data extraction; All authors have read and approved the final manuscript.
Conflict-of-interest statement: None of the authors has any conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Salim Surani, MD, Professor, Department of Medicine and Pharmacology, Texas A&M University, 40 Bizzell Street, College Station, TX 77843, United States. srsurani@hotmail.com
Received: March 25, 2025
Revised: April 28, 2025
Accepted: June 18, 2025
Published online: December 20, 2025
Processing time: 133 Days and 10.6 Hours
Core Tip

Core Tip: This systematic review and meta-analysis evaluate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in patients undergoing chronic hemodialysis (HD). Elevated NLR was significantly associated with increased all-cause and cardiovascular mortality in this population. By pooling adjusted hazard ratios and assessing heterogeneity and diagnostic performance via the area under the curve, the study highlights NLR as a potentially valuable and accessible biomarker for risk stratification in HD patients. Findings support its clinical use, while emphasizing the need for standardized cutoffs and prospective validation.