Predictive value of the Naples Prognostic Score for rapid kidney function decline in stage 3–4 CKD: a multicenter study

This study aimed to evaluate the potential clinical value of the Naples Prognostic Score (NPS) in predicting rapid 12-month kidney function decline (RKFD) in predialysis stage 3-4 chronic kidney disease (CKD) patients. A retrospective analysis was conducted using data from 404 CKD patients who were consecutively enrolled at two centers between December 2023 and September 2024. All included patients had at least 12 months of follow-up available for outcome assessment. Participants were categorized based on the presence or absence of RKFD, defined as an absolute decrease in eGFR of > 5 mL/min/1.73 m² over 12 months. Clinical, laboratory, and nutritional-inflammatory parameters were compared between groups. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed to evaluate the predictive performance of NPS. RKFD occurred in 105 participants (26.0%). Individuals with RKFD exhibited significantly impaired inflammatory and nutritional markers (higher neutrophil-to-lymphocyte ratio [NLR], lower lymphocyte-to-monocyte ratio [LMR], reduced serum albumin, and lower total cholesterol). NPS was independently associated with RKFD (OR = 7.86 per 1-point increase; 95% CI: 5.22-12.60; p < 0.001) and demonstrated high discriminative performance (AUC = 0.912; optimism-corrected AUC = 0.913). NPS was independently associated with short-term RKFD in patients with stage 3-4 CKD. Its discriminative performance in this cohort suggests potential clinical relevance for identifying patients at increased risk of early kidney function deterioration, although confirmation in externally validated prospective studies is required.