Monocyte-to-Lymphocyte Ratio as a Marker of Cardiovascular Risk in Individuals with Chronic Kidney Disease: A Systematic Review of Observational Studies
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Aim
To evaluate the association between monocyte-to-lymphocyte ratio (MLR) and cardiovascular outcomes in chronic kidney disease (CKD).
Methods
We systematically searched Medline, EMBASE, Web of Science, and Scopus from inception to May 28, 2025. We included peer-reviewed observational studies assessing MLR and cardiovascular outcomes or all-cause death in CKD. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Newcastle-Ottawa Scale. Findings were narratively synthesized and p-values pooled using Fisher’s method. Statistical significance was set at p < 0.05.
Results
Eleven studies (n = 18,631) met our inclusion criteria. The study population ranged from non-dialysis CKD to end-stage kidney disease on dialysis, with follow-up from 1 to 24 months. Five studies (n = 16,974) examined cardiovascular death and generally reported significant associations with elevated MLR; Fisher’s method indicated strong overall evidence (p < 0.001). Six studies (n = 4,587) assessed cardiovascular events, yielding inconsistent findings, although some reported significant associations and identified predictive thresholds (e.g., 0.43). Five studies (n = 15,682) showed increased risk of all-cause death with increasing MLR and a predictive threshold of 0.63. Fisher’s method again supported strong overall evidence (p < 0.001). All except one of the eleven studies were rated as good quality.
Conclusion
Elevated MLR could predict cardiovascular and all-cause death in CKD. Evidence for cardiovascular events remains inconsistent, and thresholds proposed in individual studies may not be generalizable. Large-scale, multi-ethnic, and prospective studies with standardized protocols are needed to validate MLR’s role in cardiovascular risk stratification.
