Atherogenic index of plasma predicts progression of diabetic kidney disease

Background The atherogenic index of plasma (AIP), calculated as the logarithm of the triglyceride-to-high-density lipoprotein–cholesterol ratio, reflects atherogenic dyslipidemia common in type 2 diabetes (T2D). Methods This longitudinal cohort study included 936 adults with type 2 diabetes. Baseline AIP was calculated as log10(triglyceride/high-density lipoprotein cholesterol), and was analyzed continuously and by quartiles. The outcomes were albuminuria progression and sustained ≥50% decline in estimated glomerular filtration rate (eGFR). Associations were assessed using Cox proportional hazards models adjusted for demographic, metabolic, and baseline kidney measures. Results Higher AIP was independently associated with greater hazards of kidney outcomes. Each standard-deviation increase in AIP was associated with albuminuria progression (adjusted hazard ratio [HR] 1.25, 95% confidence interval [CI] 1.06–1.47, P = 0.007) and sustained eGFR decline (adjusted HR 1.59, 95% CI 1.25–2.02, P < 0.001). Compared with the lowest AIP quartile, the highest quartile was associated with higher risks of albuminuria progression (adjusted HR 2.09, 95% CI 1.23–3.57, P = 0.007) and eGFR decline (adjusted HR 3.32, 95% CI 1.53–7.24, P = 0.002). Associations were directionally consistent across subgroups. Conclusion Atherogenic index of plasma may serve as a simple marker of diabetic kidney disease progression risk in T2D, with stronger associations for eGFR loss than for albuminuria progression.