{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:56:24Z","timestamp":1792000584027,"version":"4.4.0"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003787","name":"Natural Science Foundation of Hebei Province","doi-asserted-by":"publisher","award":["H2025423132"],"award-info":[{"award-number":["H2025423132"]}],"id":[{"id":"10.13039\/501100003787","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013254","name":"National College Students Innovation and Entrepreneurship Training Program","doi-asserted-by":"publisher","award":["202414432005"],"award-info":[{"award-number":["202414432005"]}],"id":[{"id":"10.13039\/501100013254","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The hemoglobin, albumin, lymphocytes and platelets (HALP) score, a novel nutritional and inflammatory biomarker, has been used in various chronic disease studies. However, the relationship between the HALP score and chronic kidney disease (CKD) remains poorly elucidated. This study aimed to explore the association between the HALP score and CKD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Our analysis encompassed 25,181 adult participants drawn from NHANES cycles spanning 2009\u20132018. Weighted multivariable logistic regression and generalized additive models (GAMs) were employed to evaluate the independent associations between the HALP score and three outcomes: CKD, albuminuria, and low-estimated glomerular filtration rate (eGFR). CKD was defined as albuminuria (urinary albumin-to-creatinine ratio\u2009\u2265\u200930 mg\/g) or low-eGFR (eGFR\u2009&lt;\u200960 mL\/min\/1.73m\n                      <jats:sup>2<\/jats:sup>\n                      ). Threshold effects were examined using two-piecewise linear regression. Subgroup and sensitivity analyses were performed to assess robustness. Receiver operating characteristic (ROC) curve analyses were applied to compare the discriminative capacity of the HALP score with the prognostic nutritional index (PNI), systemic immune-inflammation index (SII), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR). A 5\/6 nephrectomy rat model of CKD was established to evaluate the HALP values and their components.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After adjustment for multiple confounders, higher HALP scores were inversely associated with prevalent CKD (OR = 0.97, 95% CI: 0.94\u20130.99) and albuminuria (OR = 0.97, 95% CI: 0.93\u20130.99). However, the association between the HALP score and low-eGFR was no longer statistically significant in Model 3. Non-linear analyses revealed a threshold pattern, with higher HALP scores inversely associated with prevalent CKD up to an inflection point of 52.43 (OR = 0.97, 95% CI: 0.95\u20130.99), beyond which no significant association was observed. For albuminuria, the corresponding inflection point was 49.82. Subgroup and interaction analyses indicated no meaningful effect modification by age, sex, BMI, hypertension, or diabetes. Sensitivity analyses confirmed the robustness of the results. ROC analysis demonstrated that the HALP score had modestly higher AUCs for CKD and albuminuria compared with PNI, SII, LMR, and PLR. In the animal experiment, CKD rats exhibited significantly lower calculated HALP values, which were inversely correlated with serum creatinine (Scr), blood urea nitrogen (BUN), and urinary albumin-to-creatinine ratio (UACR), further supporting the biological plausibility of the HALP\u2013CKD association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this cross-sectional study, lower HALP scores are independently associated with a higher prevalence of CKD and albuminuria. As an affordable and readily measurable composite index, a low HALP score may represent a complementary marker of prevalent CKD, while its clinical utility requires prospective validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0353085","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:35:58Z","timestamp":1791999358000},"page":"e0353085","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between the hemoglobin albumin lymphocyte and platelet score and chronic kidney disease: Insights from patient data and animal models"],"prefix":"10.1371","volume":"21","author":[{"given":"Wenyu","family":"Zhang","sequence":"first","affiliation":[{"name":"Hebei University of Chinese Medicine","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yashi","family":"Wang","sequence":"additional","affiliation":[{"name":"Hebei University of Chinese Medicine","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenfeng","family":"Ye","sequence":"additional","affiliation":[{"name":"Hebei University of Chinese Medicine","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiman","family":"Wang","sequence":"additional","affiliation":[{"name":"Hebei University of Chinese Medicine","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuejing","family":"Chen","sequence":"additional","affiliation":[{"name":"Hebei University of Chinese Medicine","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingwu","family":"Zhao","sequence":"additional","affiliation":[{"name":"Hebei University of Chinese Medicine","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueqin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Hebei University of Chinese Medicine","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6590-739X","authenticated-orcid":true,"given":"Zhiqiang","family":"Chen","sequence":"additional","affiliation":[{"name":"Hebei University of Chinese Medicine","place":["Shijiazhuang, Hebei, China"]},{"name":"The First Affiliated Hospital of Hebei University of Chinese Medicine","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"issue":"10","key":"pone.0353085.ref001","doi-asserted-by":"crossref","first-page":"2203","DOI":"10.3390\/biomedicines12102203","article-title":"Chronic kidney disease progression - A challenge","volume":"12","author":"S Maringhini","year":"2024","journal-title":"Biomedicines"},{"key":"pone.0353085.ref002","first-page":"101275","article-title":"Characteristics of patients with undiagnosed stage 3 chronic kidney disease: Results from an observational study (REVEAL-CKD) in China","volume":"54","author":"S Nie","year":"2025","journal-title":"Lancet Reg Health West Pac"},{"issue":"6","key":"pone.0353085.ref003","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1097\/MNH.0b013e32834ad504","article-title":"Inflammation as a risk factor and target for therapy in chronic kidney disease","volume":"20","author":"T Miyamoto","year":"2011","journal-title":"Curr Opin Nephrol Hypertens"},{"issue":"2","key":"pone.0353085.ref004","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1007\/s11255-023-03740-9","article-title":"Association between controlling nutritional status score and chronic kidney disease in diabetic patients: A cross-sectional study based on the National Health and Nutrition Examination Survey","volume":"56","author":"W Qu","year":"2024","journal-title":"Int Urol Nephrol"},{"issue":"5","key":"pone.0353085.ref005","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1002\/ncp.11040","article-title":"Malnutrition accelerates the occurrence of infectious complications in patients with chronic kidney disease: A cross-sectional survey of 682 patients with chronic kidney disease","volume":"38","author":"W Wang","year":"2023","journal-title":"Nutr Clin Pract"},{"key":"pone.0353085.ref006","doi-asserted-by":"crossref","first-page":"1329256","DOI":"10.3389\/fendo.2024.1329256","article-title":"Association between systemic inflammation response index and chronic kidney disease: A population-based study","volume":"15","author":"X Li","year":"2024","journal-title":"Front Endocrinol (Lausanne)"},{"key":"pone.0353085.ref007","doi-asserted-by":"crossref","first-page":"1430471","DOI":"10.3389\/fnut.2024.1430471","article-title":"Association between advanced lung cancer inflammation index and chronic kidney disease: A cross-sectional study","volume":"11","author":"X Li","year":"2024","journal-title":"Front Nutr"},{"issue":"38","key":"pone.0353085.ref008","doi-asserted-by":"crossref","first-page":"41370","DOI":"10.18632\/oncotarget.5629","article-title":"Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: A retrospective cohort study","volume":"6","author":"X-L Chen","year":"2015","journal-title":"Oncotarget"},{"issue":"1","key":"pone.0353085.ref009","doi-asserted-by":"crossref","first-page":"2486558","DOI":"10.1080\/0886022X.2025.2486558","article-title":"Machine learning algorithms for diabetic kidney disease risk predictive model of Chinese patients with type 2 diabetes mellitus","volume":"47","author":"L-X Zou","year":"2025","journal-title":"Ren Fail"},{"issue":"1","key":"pone.0353085.ref010","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1186\/s40001-024-02148-0","article-title":"The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is associated with severe renal tubular atrophy\/interstitial fibrosis in IgA nephropathy","volume":"29","author":"X Liang","year":"2024","journal-title":"Eur J Med Res"},{"issue":"7","key":"pone.0353085.ref011","article-title":"HALP score for predicting renal relapse in lupus nephritis: A nested case-control study","volume":"31","author":"JA Mar\u00edn-Corte","year":"2025","journal-title":"J Clin Rheumatol"},{"issue":"11","key":"pone.0353085.ref012","doi-asserted-by":"crossref","first-page":"1751","DOI":"10.3390\/medicina60111751","article-title":"The importance of biochemical parameters, immunonutritional status, and social support for quality of life in chronic hemodialysis patients","volume":"60","author":"B Babovic","year":"2024","journal-title":"Medicina (Kaunas)"},{"issue":"1","key":"pone.0353085.ref013","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1007\/s11255-025-04679-9","article-title":"The prognostic role of hemoglobin, albumin, lymphocyte, and platelets score in peritoneal dialysis","volume":"58","author":"X Guo","year":"2026","journal-title":"Int Urol Nephrol"},{"key":"pone.0353085.ref014","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.ddmod.2010.08.002","article-title":"Models of chronic kidney disease","volume":"7","author":"H-C Yang","year":"2010","journal-title":"Drug Discov Today Dis Models"},{"issue":"1","key":"pone.0353085.ref015","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s12325-021-01927-z","article-title":"A narrative review of chronic kidney disease in clinical practice: current challenges and future perspectives","volume":"39","author":"M Evans","year":"2022","journal-title":"Adv Ther"},{"key":"pone.0353085.ref016","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1159\/000479257","article-title":"Inflammation: A key contributor to the genesis and progression of chronic kidney disease","volume":"191","author":"Q Qian","year":"2017","journal-title":"Contrib Nephrol"},{"issue":"7","key":"pone.0353085.ref017","doi-asserted-by":"crossref","first-page":"1760","DOI":"10.1016\/j.clnu.2024.05.037","article-title":"Malnutrition as a potential predictor of mortality in chronic kidney disease patients on dialysis: A systematic review and meta-analysis","volume":"43","author":"I Rashid","year":"2024","journal-title":"Clin Nutr"},{"key":"pone.0353085.ref018","doi-asserted-by":"crossref","first-page":"103081","DOI":"10.1016\/j.pmedr.2025.103081","article-title":"Association of Hemoglobin, albumin, lymphocyte, and platelet scores with the risk of overactive bladder syndrome in U.S. adults: A Nationwide cross-sectional study","volume":"54","author":"M Jin","year":"2025","journal-title":"Prev Med Rep"},{"key":"pone.0353085.ref019","doi-asserted-by":"crossref","first-page":"1241217","DOI":"10.3389\/fcvm.2023.1241217","article-title":"Hemoglobin albumin lymphocyte and platelet score and all-cause mortality in coronary heart disease: A retrospective cohort study of NHANES database","volume":"10","author":"Y Zheng","year":"2023","journal-title":"Front Cardiovasc Med"},{"issue":"6","key":"pone.0353085.ref020","first-page":"412","article-title":"Association between hemoglobin albumin lymphocyte and platelet (HALP) score and psoriasis: Evidence from NHANES","volume":"117","author":"M Fan","year":"2025","journal-title":"J Natl Med Assoc"},{"key":"pone.0353085.ref021","doi-asserted-by":"crossref","first-page":"1339921","DOI":"10.3389\/fendo.2024.1339921","article-title":"Haemoglobin, albumin, lymphocyte, and platelet score as an independent predictor for renal prognosis in IgA nephropathy","volume":"15","author":"Y Yuan","year":"2024","journal-title":"Front Endocrinol (Lausanne)"},{"key":"pone.0353085.ref022","doi-asserted-by":"crossref","first-page":"1356929","DOI":"10.3389\/fendo.2024.1356929","article-title":"The L-shape relationship between hemoglobin, albumin, lymphocyte, platelet score and the risk of diabetic retinopathy in the US population","volume":"15","author":"R Ding","year":"2024","journal-title":"Front Endocrinol (Lausanne)"},{"key":"pone.0353085.ref023","article-title":"Association between hemoglobin, albumin, lymphocyte, and platelet score and diabetic foot ulcer: A cross-sectional study","author":"Z Li","year":"2025","journal-title":"Int J Low Extrem Wounds"},{"issue":"5","key":"pone.0353085.ref024","doi-asserted-by":"crossref","first-page":"705","DOI":"10.7326\/ANNALS-24-01926","article-title":"Evaluation and management of chronic kidney disease: Synopsis of the kidney disease: Improving Global Outcomes 2024 clinical practice guideline","volume":"178","author":"M Madero","year":"2025","journal-title":"Ann Intern Med"},{"issue":"1","key":"pone.0353085.ref025","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.kint.2020.10.012","article-title":"The case for early identification and intervention of chronic kidney disease: Conclusions from a kidney disease: Improving Global Outcomes (KDIGO) Controversies Conference","volume":"99","author":"MG Shlipak","year":"2021","journal-title":"Kidney Int"},{"issue":"1","key":"pone.0353085.ref026","doi-asserted-by":"crossref","first-page":"33","DOI":"10.2215\/CJN.05600612","article-title":"Factors associated with CKD in the elderly and nonelderly population","volume":"8","author":"M-Y Lin","year":"2013","journal-title":"Clin J Am Soc Nephrol"},{"issue":"10","key":"pone.0353085.ref027","article-title":"Anemia and hypoxia impact on chronic kidney disease onset and progression: Review and updates","volume":"15","author":"E Habas","year":"2023","journal-title":"Cureus"},{"key":"pone.0353085.ref028","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.ejim.2018.04.014","article-title":"Human serum albumin in cardiovascular diseases","volume":"52","author":"S Arques","year":"2018","journal-title":"Eur J Intern Med"},{"issue":"12","key":"pone.0353085.ref029","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1038\/s41581-024-00875-5","article-title":"Lymphocytes and innate immune cells in acute kidney injury and repair","volume":"20","author":"K Lee","year":"2024","journal-title":"Nat Rev Nephrol"},{"key":"pone.0353085.ref030","doi-asserted-by":"crossref","first-page":"2712","DOI":"10.3389\/fimmu.2018.02712","article-title":"Role of platelets in leukocyte recruitment and resolution of inflammation","volume":"9","author":"J Rossaint","year":"2018","journal-title":"Front Immunol"},{"issue":"8","key":"pone.0353085.ref031","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1007\/s11306-019-1569-3","article-title":"Tissue, urine and blood metabolite signatures of chronic kidney disease in the 5\/6 nephrectomy rat model","volume":"15","author":"MA Hanifa","year":"2019","journal-title":"Metabolomics"},{"issue":"9","key":"pone.0353085.ref032","doi-asserted-by":"crossref","first-page":"1546","DOI":"10.2215\/CJN.13121215","article-title":"Inflammation and progression of CKD: The CRIC study","volume":"11","author":"RL Amdur","year":"2016","journal-title":"Clin J Am Soc Nephrol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0353085","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:36:05Z","timestamp":1791999365000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0353085"}},"subtitle":[],"editor":[{"given":"Donovan Anthony","family":"McGrowder","sequence":"first","affiliation":[{"name":"The University of the West Indies","place":["JAMAICA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,14]]},"references-count":32,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0353085","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,14]]}}}