Negative association of C-reactive protein-albumin-lymphocyte index (CALLY index) with all-cause and cardiovascular mortality in population with CKD: the mediating role of biological age acceleration.

This study investigated the association between the C-reactive protein-albumin-lymphocyte (CALLY) index and all-cause mortality and cardiovascular disease (CVD) mortality in patients with chronic kidney disease(CKD) while exploring biological aging as a potential mediator. This study included 4,515 patients with CKD from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2010. The CALLY index was assessed only at baseline. The association between the CALLY index and all-cause and cardiovascular mortality was analyzed using Cox proportional hazards models. Additionally, Kaplan-Meier curves, smooth curve fitting, segmented linear regression, and various subgroup and sensitivity analyses were performed. Finally, the mediating role of biological age acceleration was explored. Among 4,515 participants, with a median follow-up of 127 months and 2,264 recorded deaths, a higher Ln-CALLY was associated with a lower risk of all-cause mortality (HR = 0.845, 95% CI: 0.817, 0.874) and cardiovascular disease (CVD) mortality (HR = 0.860, 95% CI: 0.809, 0.915). Smoothed curve fitting and threshold effect analyses indicated that the effect was more pronounced when Ln-CALLY was lower than 4.96. Mediation analyses further revealed that biological age acceleration (BioAgeAccel) mediated 14.168% of the association between CALLY and all-cause mortality and 27.442% associated with CVD mortality. In the CKD population, CALLY values were negatively associated with all-cause and cardiovascular mortality, with BioAgeAccel significantly mediating this relationship.