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帮我生成图片：Abstract Chronic kidney disease (CKD) is a major global health burden strongly linked to cardiovascular mortality. Traditional obesity indices such as body mass index (BMI) and waist circumference (WC) incompletely capture adiposity risk in CKD. The weight-adjusted waist index (WWI) is an emerging anthropometric measure, but its prognostic value in CKD has not been fully established. This study investigates the association between the weight-adjusted waist index (WWI) and mortality outcomes—CVD-specific and all-cause—among individuals with CKD. This retrospective cohort study utilized data from the National Health and Nutrition Examination Survey (NHANES 2005–2018) and the National Death Index (NDI). During a median follow-up of 79 months, among 5,381 participants, higher WWI quartiles were associated with progressively elevated risks of CVD (highest vs. lowest quartile OR: 1.81, 95% CI: 1.39–2.34) and mortality (CVD HR: 1.73, 95% CI: 1.15–2.60; all-cause HR: 1.45, 95% CI: 1.22–1.72). Subgroup and sensitivity analyses confirmed the robustness of these findings. Mediation analysis indicated that both the neutrophil-to-lymphocyte ratio (NLR) and systemic inflammation response index (SIRI) significantly mediated the associations between WWI and all-cause mortality, as well as between WWI and CVD-specific mortality. In the fully adjusted Model 2, ROC curve analysis revealed area under the curve (AUC) values for WWI with CVD mortality and all-cause mortality of 0.793 and 0.763, respectively. This study provides the first evidence that WWI is significantly associated with CVD risk and mortality outcomes, including both CVD-specific and all-cause mortality, in U.S. CKD populations. Mediation analysis suggested that NLR and SIRI partially mediated the relationship between WWI and these mortality outcomes Make high quality graphical abstract