Elevated atherogenic index and higher triglyceride increase risk of kidney function decline: a 7-year cohort study in Chinese adults

This study explored whether lipid disorders or an elevated atherogenic index of plasma (AIP, a risk factor for cardiovascular diseases) could predict major kidney function decline. We conducted a retrospective 7-year cohort study of 3712 Chinese adults followed up between 2010 and 2017. Major kidney function decline was defined as a ≥ 30% reduction in the estimated glomerular filtration rate (eGFR) from baseline. Multivariable logistic regression models were used to evaluate the relationship between lipid profiles and major kidney function decline. Smoking habits, waist circumference, and physical activity were not assessed. During the 7-year follow-up, 1.70% (n = 63) of the participants developed major kidney function decline. After adjustment for potential confounders, the odds ratios (ORs) for developing eGFR decline with per standard deviation increase were 1.23 [95% confidence interval (CI): 1.06–1.43] for triglyceride and 2.55 (95% CI: 1.01–6.42) for AIP in all participants. Furthermore, in the stratified analysis, we found sex-related differences; triglyceride and AIP were only independently associated with the risk of eGFR decline in men (OR, 1.27, 95% CI: 1.08–1.48; OR, 3.98, 95% CI: 1.22–12.99, respectively). When the participants were divided into groups according to the baseline lipid status, association was observed only between abnormal AIP and eGFR decline (all p values Our findings suggest that a higher serum triglyceride level or an elevated AIP increases the risk of major kidney function decline in Chinese men with normal kidney function. Thus, assessment of AIP may help identify the risk of eGFR decline.

本研究旨在探讨血脂异常或血浆致动脉粥样硬化指数（atherogenic index of plasma, AIP，一种心血管疾病风险因子）能否预测肾功能大幅下降。我们于2010至2017年间开展了一项为期7年的回顾性队列研究，共纳入3712名中国成人受试者并完成随访。肾功能大幅下降被定义为估算肾小球滤过率（estimated glomerular filtration rate, eGFR）较基线水平降低≥30%。本研究采用多变量logistic回归模型评估血脂谱与肾功能大幅下降之间的关联，未对吸烟习惯、腰围及体力活动水平进行评估。在7年随访期间，共有1.70%（n=63）的受试者出现肾功能大幅下降。在校正潜在混杂因素后，所有受试者中，每经1个标准差升高的甘油三酯对应的估算肾小球滤过率下降比值比（odds ratios, OR）为1.23[95%置信区间（confidence interval, CI）：1.06~1.43]，血浆致动脉粥样硬化指数对应的OR为2.55（95%CI：1.01~6.42）。进一步分层分析显示存在性别差异：仅在男性受试者中，甘油三酯与血浆致动脉粥样硬化指数才与估算肾小球滤过率下降风险呈独立相关（OR分别为1.27，95%CI：1.08~1.48；3.98，95%CI：1.22~12.99）。当按基线血脂状态对受试者进行分组时，仅异常血浆致动脉粥样硬化指数与估算肾小球滤过率下降存在关联（所有P值）。本研究结果表明，血清甘油三酯水平升高或血浆致动脉粥样硬化指数升高会增加基线肾功能正常的中国成年男性发生肾功能大幅下降的风险。因此，检测血浆致动脉粥样硬化指数有助于识别估算肾小球滤过率下降的风险。