{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T13:32:06Z","timestamp":1770730326401,"version":"3.49.0"},"reference-count":27,"publisher":"S. Karger AG","issue":"2","license":[{"start":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T00:00:00Z","timestamp":1760745600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T00:00:00Z","timestamp":1760745600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nephron"],"abstract":"<jats:p>Introduction: Elevated monocyte to lymphocyte ratio (MLR) represents a pro-inflammatory immune microenvironment and has been associated with poor clinical outcomes such as cardiovascular disease. However, little is known about its association with outcomes among patients on hemodialysis. Methods: In a nationwide prospective cohort of 952 patients receiving maintenance hemodialysis from 2011\u20132013, we examined the association of baseline MLR with subsequent risk of cardiovascular events (cardiovascular-related hospitalization and cardiovascular death) and all-cause mortality, using multivariable Cox proportional-hazards models with adjustment for potential confounders. We also examined the mediation effect of inflammatory markers on the association between MLR and cardiovascular events and all-cause mortality, respectively. Results: Overall, patients were 60.1 \u00b1 13.4 years old; 53.3% were male; 39.7% were African American; and 56.9% were diabetic. The median dialysis vintage was 3.1 years. During a median follow-up of 2.1 years, 184 and 207 cases experienced cardiovascular events and all-cause death, respectively. A higher MLR was incrementally associated with higher risk of cardiovascular events and all-cause mortality. The multivariable-adjusted hazard ratios (95% confidence interval) of cardiovascular events and all-cause mortality for 0.1-unit increase in MLR were 1.22 (1.09\u20131.37) and 1.18 (1.07\u20131.30), respectively. There was a modest but significant mediation effect of plasma interleukin-6 (IL-6) on the association between MLR and cardiovascular events (28.2%) and all-cause mortality (24.1%). Conclusion: A higher MLR was independently associated with higher risk of cardiovascular events and all-cause mortality in patients on hemodialysis. Our findings suggest the potential of MLR as a simple, cost-effective prognostic biomarker and support IL-6-targeted therapeutic interventions to improve clinical outcomes in patients with ESKD.<\/jats:p>","DOI":"10.1159\/000549074","type":"journal-article","created":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T16:01:02Z","timestamp":1760803262000},"page":"76-86","source":"Crossref","is-referenced-by-count":0,"title":["Association of Monocyte-Lymphocyte Ratio with Cardiovascular Events and All-Cause Mortality in Patients Undergoing Hemodialysis: A Prospective Cohort Study"],"prefix":"10.1159","volume":"150","author":[{"given":"Yamini","family":"Mallisetty","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Kabeil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cameron Jackson","family":"Bergeron","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhongji","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4837-3194","authenticated-orcid":false,"given":"Chi-Yang","family":"Chiu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8204-911X","authenticated-orcid":false,"given":"Csaba P.","family":"Kovesdy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keiichi","family":"Sumida","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"127","published-online":{"date-parts":[[2025,10,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ki.5002343"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1038\/nrneph.2014.185"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/1762584"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.2174\/092986711796391633"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2023.03.016"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.18632\/aging.103685"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-024-03043-1"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1007\/s42399-023-01570-5"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1634008"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.3109\/0886022X.2015.1128234"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.exphem.2020.01.011"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60439-0"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics8040071"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00256.2017"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1038\/nri3070"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1177\/03000605231204469"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1111\/hdi.12549"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1080\/15592294.2023.2214394"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1016\/j.immuni.2023.01.024"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2024.1432838"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1159\/000519289"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12155010"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1038\/nrneph.2017.78"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-022-02180-6"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2021.07.023"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1701719"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1126\/science.aan4673"}],"container-title":["Nephron"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000549074","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T17:00:57Z","timestamp":1770656457000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000549074"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,18]]},"references-count":27,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,9]]},"published-print":{"date-parts":[[2026,2,11]]}},"URL":"https:\/\/doi.org\/10.1159\/000549074","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.30390991","asserted-by":"subject"}]},"ISSN":["1660-8151","2235-3186"],"issn-type":[{"value":"1660-8151","type":"print"},{"value":"2235-3186","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,18]]}}}