The neutrophil-to-lymphocyte ratio and incident chronic kidney disease in a community-based cohort: a prospective study

Chronic kidney disease (CKD) represents a significant global health burden, highlighting the need for low-cost, easily accessible biomarkers for early risk detection. The neutrophil-to-lymphocyte ratio (NLR) has demonstrated prognostic value in established CKD; however, its association with incident CKD in the general population without uremia remains poorly understood. We conducted a prospective study of 9,631 adults with preserved renal function from the Shanghai Suburban Adult Cohort. Logistic regression analysis was performed to assess the association between baseline NLR and incident CKD. Dose-response and subgroup analyses were also conducted. During follow-up, 400 participants (4.2%) developed incident CKD. After full adjustment, each 1-unit increase in NLR was associated with a 19% increase in CKD odds (OR = 1.19, 95% CI: 1.06-1.32). A dose-response relationship was observed: compared with the low NLR group (< 1.5), the normal (1.5-3.0) and high (≥ 3.0) NLR groups exhibited 37% (OR = 1.37) and 62% (OR = 1.62) increased odds of developing CKD, respectively. In this community-based population, NLR was positively, independently, and dose-dependently associated with incident CKD risk. These findings suggest that NLR, a low-cost and easily accessible biomarker, is independently associated with incident CKD risk and warrants further validation for early risk stratification in primary care and community health settings.