Abstract: Objectives To investigate the relationship between monocyte-lymphocyte ratio (MLR) and all-cause mortality in patients with maintenance hemodialysis (MHD).  Methods This was a single-centered, retrospective and cohort study. Baseline clinical data and laboratory parameters were collected from the patients with end-stage renal disease (ESRD) and treated with MHD at the Department of Blood Purification, Nanyang Central Hospital from January 2020 to January 2022. All patients were followed up until August 2022. The relationship between MLR and all-cause mortality was analyzed in the MHD patients.  Results A total of 259 patients were enrolled in the study, including 55.2% males and with an average age of 57.0±13.9 years old. The median follow-up time was 22.0 (11.0, 27.0) months, and all-cause death occurred in 62 (23.9%) patients until the end of follow-up. Univariate Cox regression analysis showed that MLR (HR=6.251, 95% CI：2.654~14.723, P＜0.001), neutrophil/lymphocyte ratio (HR=1.119, 95% CI：1.057~1.184, P＜0.001), and systemic immune inflammatory index (HR=1.001, 95% CI：1.000~1.001, P＜0.001) were the risk factors for all-cause mortality in the MHD patients. Multivariate Cox regression analysis showed that MLR was independently correlated with the risk of all-cause mortality after adjusting the confounding factors (HR=4.81, 95% CI：1.32~17.53, P=0.017). Subgroup analysis showed that MLR as a risk factor for all-cause mortality in MHD patients was stable in different populations. Kaplan-Meier survival curve showed a gradual decrease of survival along with the increase of MLR (Log-rank test c2=12.248, P=0.007).  Conclusion  The increase of MLR is an independent risk factor for all-cause mortality in MHD patients, and is closely related to the survival rate of MHD patients.

Key words: Maintenance hemodialysis, All-cause death, Monocyte to lymphocyte ratio; , Prognosis