{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T05:14:18Z","timestamp":1783314858576,"version":"3.54.6"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients undergoing maintenance hemodialysis (MHD) remain at high risk of death. Composite inflammation-related indices may capture inflammatory burden, immune status, nutritional reserve, and lipid-related protective capacity. This study evaluated the associations of the C-reactive protein-albumin-lymphocyte (CALLY) index, C-reactive protein-to-lymphocyte ratio (CLR), and C-reactive protein-to-high-density lipoprotein cholesterol ratio (CHR) with all-cause mortality in patients receiving MHD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective two-center cohort study included adult patients undergoing maintenance hemodialysis at Shenzhen People\u2019s Hospital and Huidong People\u2019s Hospital, China. Baseline data were collected between January 2017 and October 2022, and all patients were followed until death or October 2023. CALLY, CLR, and CHR were natural log-transformed and analyzed using Cox proportional hazards models, Kaplan-Meier curves, restricted cubic splines, subgroup analyses, time-dependent receiver operating characteristic curves, and sensitivity analyses after multiple imputation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During a median follow-up of 36.67 months (IQR, 20.01\u201352.80 months), 125 patients died. In the fully adjusted Cox models, each one-unit increase in ln CALLY was associated with lower all-cause mortality risk (HR, 0.85; 95% CI, 0.77-0.94; P\u00a0=\u00a00.002), whereas ln CLR (HR, 1.19; 95% CI, 1.06-1.33; P\u00a0=\u00a00.003) and ln CHR (HR, 1.18; 95% CI, 1.07-1.31; P\u00a0=\u00a00.002) were associated with higher mortality risk. Kaplan-Meier curves showed significant survival differences across tertiles (log-rank P\u00a0=\u00a00.016, 0.012, and 0.044). Restricted cubic spline analyses showed significant overall associations (P\u00a0=\u00a00.0158, 0.0138, and 0.0301) without significant nonlinearity. The 3-year AUCs were 0.603, 0.598, and 0.563 for ln CALLY, ln CLR, and ln CHR, respectively. Sensitivity analyses yielded similar Cox regression results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ln CALLY, ln CLR, and ln CHR were independently associated with all-cause mortality in MHD patients and may serve as accessible markers for initial prognostic risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1849614","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T04:20:25Z","timestamp":1783311625000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations of CALLY, CLR, and CHR with all-cause mortality in patients receiving maintenance hemodialysis: a two-center retrospective cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Ying","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Hematology, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujian","family":"He","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital","place":["Shenzhen, Guangdong, China"]},{"name":"Shenzhen Key Laboratory of Kidney Diseases","place":["Shenzhen, Guangdong, China"]},{"name":"Shenzhen Clinical Research Center for Geriatrics, Shenzhen People's Hospital","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuting","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital","place":["Shenzhen, Guangdong, China"]},{"name":"Shenzhen Key Laboratory of Kidney Diseases","place":["Shenzhen, Guangdong, China"]},{"name":"Shenzhen Clinical Research Center for Geriatrics, Shenzhen People's Hospital","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanting","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital","place":["Shenzhen, Guangdong, China"]},{"name":"Shenzhen Key Laboratory of Kidney Diseases","place":["Shenzhen, Guangdong, China"]},{"name":"Shenzhen Clinical Research Center for Geriatrics, Shenzhen People's Hospital","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guanghao","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital","place":["Shenzhen, Guangdong, China"]},{"name":"Shenzhen Key Laboratory of Kidney Diseases","place":["Shenzhen, Guangdong, China"]},{"name":"Shenzhen Clinical Research Center for Geriatrics, Shenzhen People's Hospital","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital","place":["Shenzhen, Guangdong, China"]},{"name":"Shenzhen Key Laboratory of Kidney Diseases","place":["Shenzhen, Guangdong, China"]},{"name":"Shenzhen Clinical Research Center for Geriatrics, Shenzhen People's Hospital","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital","place":["Shenzhen, Guangdong, China"]},{"name":"Shenzhen Key Laboratory of Kidney Diseases","place":["Shenzhen, Guangdong, China"]},{"name":"Shenzhen Clinical Research Center for Geriatrics, Shenzhen People's Hospital","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijun","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Huidong People's Hospital","place":["Huizhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hualin","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital","place":["Shenzhen, Guangdong, China"]},{"name":"Shenzhen Key Laboratory of Kidney Diseases","place":["Shenzhen, Guangdong, China"]},{"name":"Shenzhen Clinical Research Center for Geriatrics, Shenzhen People's Hospital","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinzhou","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital","place":["Shenzhen, Guangdong, China"]},{"name":"Shenzhen Key Laboratory of Kidney Diseases","place":["Shenzhen, Guangdong, China"]},{"name":"Shenzhen Clinical Research Center for Geriatrics, Shenzhen People's Hospital","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1038\/s41581-018-0002-x","article-title":"Haemodialysis membranes","volume":"14","author":"Ronco","year":"2018","journal-title":"Nat Rev Nephrol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.800950","article-title":"Inflammation and cardiovascular disease associated with hemodialysis for end-stage renal disease","volume":"13","author":"Wang","year":"2022","journal-title":"Front Pharmacol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3390\/nu12103147","article-title":"Understanding development of malnutrition in hemodialysis patients: a narrative review","volume":"12","author":"Sahathevan","year":"2020","journal-title":"Nutrients"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3390\/toxins12070439","article-title":"Immune dysfunction in uremia 2020","volume":"12","author":"Cohen","year":"2020","journal-title":"Toxins (Basel)"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-025-04401-y","article-title":"Biocompatibility in hemodialysis: artificial membrane and human blood interactions","volume":"26","author":"\u00c1vila","year":"2025","journal-title":"BMC Nephrol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"18889","DOI":"10.1038\/s41598-023-46338-y","article-title":"Exploring the diagnostic and prognostic value of the C-reactive protein\/lymphocyte ratio for dilated cardiomyopathy based on a real-world study","volume":"13","author":"Qi","year":"2023","journal-title":"Sci Rep"},{"key":"B7","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1186\/s12872-024-04446-1","article-title":"The predictive role of the hs-CRP\/HDL-C ratio for long-term mortality in the general population: evidence from a cohort study","volume":"24","author":"Wang","year":"2024","journal-title":"BMC Cardiovasc Disord"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.hpb.2021.06.414","article-title":"Superiority of CRP-albumin-lymphocyte index (CALLY index) as a non-invasive prognostic biomarker after hepatectomy for hepatocellular carcinoma","volume":"24","author":"Iida","year":"2022","journal-title":"HPB (Oxford)"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1163\/9789004214026_007","article-title":"The impact of C-reactive protein-albumin-lymphocyte (CALLY) index on the prognosis of patients with distal cholangiocarcinoma following pancreaticoduodenectomy","volume":"7","author":"Tsunematsu","year":"2023","journal-title":"Ann Gastroenterol Surg"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.asjsur.2024.03.054","article-title":"Prognostic usefulness of the C-reactive protein-albumin-lymphocyte (CALLY) index as a novel biomarker in patients undergoing colorectal cancer surgery","volume":"47","author":"Takeda","year":"2024","journal-title":"Asian J Surg"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2026.1729647","article-title":"Association between the C-reactive protein-albumin-lymphocyte index and cardiovascular incidence and mortality among patients with chronic kidney disease: a prospective study","volume":"17","author":"Jiang","year":"2026","journal-title":"Front Immunol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1097\/js9.0000000000001273","article-title":"C-reactive protein\/lymphocyte ratio as a prognostic biomarker in acute pancreatitis: a cross-sectional study assessing disease severity","volume":"110","author":"Chen","year":"2024","journal-title":"Int J Surg"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.2147\/jir.s517816","article-title":"Prognostic value of C-reactive protein-to-lymphocyte ratio in combined immunotherapy and chemotherapy for small cell lung cancer","volume":"18","author":"Sheng","year":"2025","journal-title":"J Inflammation Res"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1111\/1440-1681.13919","article-title":"High-sensitivity C-reactive protein to high-density lipoprotein cholesterol ratio predicts long-term adverse outcomes in patients who underwent percutaneous coronary intervention: a prospective cohort study","volume":"51","author":"Dai","year":"2024","journal-title":"Clin Exp Pharmacol Physiol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2025.1580904","article-title":"The predictive value of hsCRP\/HDL-C ratio for cardiometabolic multimorbidity in middle-aged and elderly people: evidence from a large national cohort study","volume":"12","author":"Li","year":"2025","journal-title":"Front Nutr"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3390\/toxins17070345","article-title":"Increased cardiovascular mortality in hemodialysis: the role of chronic inflammation, complement activation, and non-biocompatibility","volume":"17","author":"Peth\u0151 \u00c1","year":"2025","journal-title":"Toxins (Basel)"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1080\/0886022x.2025.2512405","article-title":"Malnutrition-inflammation-fluid overload complex syndrome and all-cause mortality in patients undergoing hemodialysis","volume":"47","author":"Tian","year":"2025","journal-title":"Ren Fail"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13237149","article-title":"Role of uremic toxins in vascular inflammation associated with chronic kidney disease","volume":"13","author":"Chermiti","year":"2024","journal-title":"J Clin Med"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23010531","article-title":"Impact of uremic toxins on endothelial dysfunction in chronic kidney disease: a systematic review","volume":"23","author":"Harlacher","year":"2022","journal-title":"Int J Mol Sci"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2025.1574489","article-title":"Vascular inflammation in chronic kidney disease: the role of uremic toxins in macrophage activation","volume":"12","author":"Jha","year":"2025","journal-title":"Front Cardiovasc Med"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.21037\/apm-21-2611","article-title":"Early albumin level and mortality in hemodialysis patients: a retrospective study","volume":"10","author":"Tang","year":"2021","journal-title":"Ann Palliat Med"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1038\/nrneph.2014.112","article-title":"Mechanisms of muscle wasting in chronic kidney disease","volume":"10","author":"Wang","year":"2014","journal-title":"Nat Rev Nephrol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23116047","article-title":"Muscle wasting in chronic kidney disease: mechanism and clinical implications-a narrative review","volume":"23","author":"Cheng","year":"2022","journal-title":"Int J Mol Sci"},{"key":"B24","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1053\/j.ajkd.2023.03.018","article-title":"Long-term trends in infection-related mortality in adults treated with maintenance dialysis","volume":"82","author":"Chong","year":"2023","journal-title":"Am J Kidney Dis"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1464338","article-title":"Cutaneous adaptive immunity and uraemia: a narrative review","volume":"15","author":"Zibandeh","year":"2024","journal-title":"Front Immunol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-023-03442-5","article-title":"Blood stream infections in chronic hemodialysis patients - characteristics and outcomes","volume":"25","author":"Schamroth Pravda","year":"2024","journal-title":"BMC Nephrol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2025.1713387","article-title":"Dysfunctional high-density lipoprotein: an updated review","volume":"12","author":"Ouyang","year":"2025","journal-title":"Front Cardiovasc Med"},{"key":"B28","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1186\/s12882-024-03808-3","article-title":"Understanding the heterogeneity and dysfunction of HDL in chronic kidney disease: insights from recent reviews","volume":"25","author":"Xu","year":"2024","journal-title":"BMC Nephrol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.immuni.2013.02.009","article-title":"Abnormal high-density lipoprotein induces endothelial dysfunction via activation of Toll-like receptor-2","volume":"38","author":"Speer","year":"2013","journal-title":"Immunity"},{"key":"B30","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1186\/s12882-022-02971-9","article-title":"Routine laboratory testing in hemodialysis: how frequently is it needed","volume":"23","author":"Chidiac","year":"2022","journal-title":"BMC Nephrol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"18360","DOI":"10.1038\/s41598-023-45502-8","article-title":"Regular laboratory testing and patient survival among patients undergoing maintenance hemodialysis: a Korean nationwide cohort study","volume":"13","author":"Kim","year":"2023","journal-title":"Sci Rep"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1849614\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T04:20:26Z","timestamp":1783311626000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1849614\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,6]]},"references-count":31,"alternative-id":["10.3389\/fendo.2026.1849614"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1849614","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,6]]},"article-number":"1849614"}}