AIP Emerges as a Potential Marker for Diabetic Kidney Risk
In an effort to identify accessible and clinically meaningful predictors of chronic kidney disease (CKD) among patients with diabetes, new findings from a cross-sectional study published in Renal Failure spotlight the atherogenic index of plasma (AIP) as a promising candidate.
Drawing on over a decade of NHANES data, Cui and colleagues examined the association between AIP and CKD prevalence in a nationally representative cohort of U.S. adults with diabetes.
Low-Cost Lipid Marker Linked to Kidney Function
AIP, calculated as the log-transformed ratio of triglycerides to HDL cholesterol, has gained traction as a surrogate marker of insulin resistance and cardiovascular risk. This study extends its relevance to renal health by showing a statistically significant association between higher AIP and increased odds of CKD in patients with diabetes.
The analysis included 2,726 diabetic adults from the NHANES cycles 2005–2016. CKD was defined by either eGFR <60 mL/min/1.73 m² or an albumin-to-creatinine ratio ≥30 mg/g.
AIP values were divided into quartiles, and associations with CKD were assessed using weighted multivariate logistic regression across three increasingly adjusted models.
Findings Consistent Across Models and Quartiles
In the fully adjusted model, AIP was independently associated with CKD:
- As a continuous variable, each unit increase in AIP increased the odds of CKD by 31% (OR: 1.31; 95% CI: 1.04–1.65; p=0.025).
- Compared to the lowest AIP quartile, the highest quartile was associated with more than a twofold increased risk of CKD (OR: 2.12; 95% CI: 1.26–3.55; p=0.005).
Subgroup analyses found that this association was consistent across sex, age, race, and BMI strata, with no significant interaction effects. A restricted cubic spline analysis revealed a linear dose-response relationship between AIP and CKD risk (p for nonlinearity = 0.56), further reinforcing the interpretability of AIP as a continuous biomarker.
Pathophysiologic Plausibility: Lipotoxicity and Renal Injury
The mechanistic rationale for this association is rooted in the complex interplay of dyslipidemia, inflammation, and kidney injury in diabetes. High AIP reflects an unfavorable lipid profile—elevated triglycerides and low HDL—that may exacerbate renal injury through multiple pathways, including:
- Promoting glomerular and tubular lipid deposition
- Amplifying oxidative stress
- Reducing HDL-mediated anti-inflammatory effects
- Contributing to mesangial expansion and fibrosis
Small, dense LDL particles (sdLDL), indirectly captured by AIP, have also been implicated in atherogenesis and nephropathy via their prolonged circulation time, ease of oxidation, and propensity to accumulate in renal tissue.
Study Strengths and Limitations
The use of NHANES data—a rigorously collected, nationally representative dataset—lends strength to the study’s generalizability. Stratified analyses across demographic and clinical subgroups further enhance its validity.
However, the study’s cross-sectional design limits causal inference. Residual confounding from unmeasured variables, such as genetic predisposition and dietary patterns, may persist despite adjustments. Additionally, AIP is influenced by fasting lipid levels, which can vary over time and may not reflect long-term lipid burden.
Clinical Takeaway
AIP may serve as a low-cost, non-invasive tool for identifying diabetic patients at higher risk of CKD. While not a replacement for established renal markers, it offers complementary information that could support earlier intervention, particularly in resource-constrained settings.
However, prospective longitudinal studies are needed to confirm whether AIP predicts incident CKD and whether modifying AIP influences renal outcomes.
Reference:
Cui M, Xiao X, Zhao X, et al. Association between the atherogenic index of plasma and chronic kidney disease: an evaluation of an adult population of American patients with diabetes mellitus. Ren Fail. 2025;47(1):2556495. doi:10.1080/0886022X.2025.2556495