The Association of Monocyte Count and Monocyte-to-Lymphocyte Ratio with the Risk of Cardiovascular Outcomes in Patients with Chronic Kidney Disease

Background: Emerging evidence suggests an association of higher monocyte count and monocyte-to-lymphocyte ratio (MLR) with the risk of cardiovascular disease (CVD) in individuals without chronic kidney disease (CKD); however, limited studies have examined if this association translates to a CKD population. This study examined whether monocyte count and MLR are associated with the risk of CVD, CVD death, and all-cause death in patients with non-dialysis CKD who participated in the Chronic Renal Insufficiency Cohort observational study. Methods: Baseline monocyte count and MLR were categorized into tertiles and also modeled continuously. Cox proportional-hazards models were used to examine the association between monocyte count (primary predictor) and MLR (secondary predictor) at baseline and time to a composite of CVD events including heart failure, myocardial infarction, ischemic stroke, and peripheral artery disease (primary outcome). Secondary outcomes were time to CVD death and all-cause death. Results: The median follow-up time was 9.0 years for CVD events and 11.7 years for death. In the fully adjusted model, participants with a higher monocyte count and MLR had a greater risk of CVD [hazard ratio (HR) per doubling of monocyte count: 1.20 (95% CI: 1.10-1.31); HR per doubling of MLR: 1.26 (95% CI: 1.16-1.36)], CVD death [HR: 1.18 (95% CI: 0.99-1.41); HR: 1.27 (95% CI: 1.10-1.48)], and all-cause death [HR: 1.17 (95% CI: 1.06-1.30); HR: 1.18 (95% CI: 1.09-1.29)]. Conclusion: These results suggest that monocyte count and MLR may have the potential to be cost-effective, clinically available indicators of CVD risk in a CKD population.