Association between systemic immune-inflammation index and risk of chronic kidney disease; a systematic review and meta-analysis

Abstract

Introduction: Inflammation is a hallmark feature of chronic kidney disease (CKD) and the systemic immune-inflammation index (SII) is a potent biomarker for assessing the inflammatory status. Taking note of these, the present systematic review and meta-analysis evaluated the correlation between SII and the risk for CKD. Materials and Methods: ProQuest, Embase, PubMed, Web of Science, Cochrane, and Google Scholar databases were searched until November 20, 2024, without any restriction applied. Data were analyzed in Stata v14.0. The results with P<0.05 were considered to be statistically significant. Results: Elevated SII values enhanced the overall risk of CKD (OR: 1.24; 95 CI: 1.52, 1.267), CKD risk in females (OR: 1.03; 95 CI: 1, 1.07), and CKD risk in the USA (OR: 1.27; 95 CI: 1.16, 1.38). Contrarily, no significant correlation was observed between SII and the risk for CKD among males (OR: 1.03; 95 CI: 0.99, 1.07) and in China (OR: 1.15; 95 CI: 0.98, 1.34). The second tertile (OR: 1.14; 95 CI: 1.05, 1.25), third tertile (OR: 1.49; 95 CI: 1.28, 1.73), third quartile (OR: 1.16; 95 CI: 1.08, 1.24), and fourth quartile (OR: 1.42; 95 CI: 1.27, 1.59) of the SII index enhanced the risk of CKD. Elevated SII values (OR: 1.43; 95 CI: 1.20, 1.70) enhanced the risk for CKD. Likewise, high SII values enhanced the risk for CKD in patients with diabetes mellitus (DM) (OR: 1.42; 95 CI: 1.21, 1.68), low-estimated glomerular filtration rate (eGFR) (OR: 1.27; 95 CI: 1.14, 1.40), and albuminuria (OR: 1.46; 95 CI: 1.08, 1.97), as well as in patients with BMI>30 kg/m² (OR: 1.05; 95 CI: 1.01, 1.09). Conclusion: Elevated SII values enhanced the risk of CKD, and the SII-CKD association was intensified in females, Americans, and patients with DM, low eGFR, albuminuria, and obesity. Accordingly, high SII levels are a robust indicator of CKD prognosis. Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO (ID: CRD42024619311) and Research Registry (UIN: reviewregistry1925,) websites. © 2025 The Author(s).