The association between nutritional-inflammatory status and chronic kidney disease prognosis: a population-based study

Chronic kidney disease (CKD) prognosis is closely tied to the interplay between nutrition and inflammation. However, comprehensive nutritional-inflammatory indices for prognostic evaluation are rare in CKD. This study explored the association of the advanced lung cancer inflammation index (ALI) with estimated glomerular filtration rate (eGFR) and all-cause mortality in CKD patients. A total of 1,982 CKD patients from the National Health and Nutrition Examination Survey (NHANES) database (2011<b>–</b>2018) were included in the analysis. Analytical methods included linear regression, cox regression, and restricted cubic spline (RCS) analysis. Subgroup and sensitivity analyses were performed, and further evaluation was conducted using the receiver operating characteristic (ROC) curve and C-index for all-cause mortality across different CKD stages. Among CKD patients, 1,103 patients (55.7%) were classified as stage I–II, and 879 patients (44.3%) as stage III–V. After adjusting covariates, ALI was found to be positively correlated with eGFR (Beta = 0.11; 95% CI: 0.07–0.15), and negatively related with all-cause mortality (HR = 0.72; 95% CI: 0.63–0.83). Subgroup analysis showed that the positive correlation between ALI and eGFR was stronger in CKD stage III–V compared to stage I–II. However, ALI’s protective effect on mortality was weaker in stage III–V. The C-index for ALI was 0.648 in stage I–II and 0.660 in stage III–V. ALI was significantly associated with eGFR and all-cause mortality in CKD patients. Nutritional and anti-inflammatory interventions in early-stage CKD may improve prognosis, and ALI may have great potential as a multifaceted biomarker to influence the prognosis of CKD, particularly in stages III–V.