Associations of CALLY, CLR, and CHR with all-cause mortality in patients receiving maintenance hemodialysis: a two-center retrospective cohort study.

BACKGROUND

Patients undergoing maintenance hemodialysis (MHD) remain at high risk of death. Composite inflammation-related indices may capture inflammatory burden, immune status, nutritional reserve, and lipid-related protective capacity. This study evaluated the associations of the C-reactive protein-albumin-lymphocyte (CALLY) index, C-reactive protein-to-lymphocyte ratio (CLR), and C-reactive protein-to-high-density lipoprotein cholesterol ratio (CHR) with all-cause mortality in patients receiving MHD.

METHODS

This retrospective two-center cohort study included adult patients undergoing maintenance hemodialysis at Shenzhen People's Hospital and Huidong People's Hospital, China. Baseline data were collected between January 2017 and October 2022, and all patients were followed until death or October 2023. CALLY, CLR, and CHR were natural log-transformed and analyzed using Cox proportional hazards models, Kaplan-Meier curves, restricted cubic splines, subgroup analyses, time-dependent receiver operating characteristic curves, and sensitivity analyses after multiple imputation.

RESULTS

During a median follow-up of 36.67 months (IQR, 20.01-52.80 months), 125 patients died. In the fully adjusted Cox models, each one-unit increase in ln CALLY was associated with lower all-cause mortality risk (HR, 0.85; 95% CI, 0.77-0.94; P = 0.002), whereas ln CLR (HR, 1.19; 95% CI, 1.06-1.33; P = 0.003) and ln CHR (HR, 1.18; 95% CI, 1.07-1.31; P = 0.002) were associated with higher mortality risk. Kaplan-Meier curves showed significant survival differences across tertiles (log-rank P = 0.016, 0.012, and 0.044). Restricted cubic spline analyses showed significant overall associations (P = 0.0158, 0.0138, and 0.0301) without significant nonlinearity. The 3-year AUCs were 0.603, 0.598, and 0.563 for ln CALLY, ln CLR, and ln CHR, respectively. Sensitivity analyses yielded similar Cox regression results.

CONCLUSIONS

ln CALLY, ln CLR, and ln CHR were independently associated with all-cause mortality in MHD patients and may serve as accessible markers for initial prognostic risk stratification.