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The atherogenic index of plasma and the risk of mortality in incident dialysis patients: Results from a nationwide prospective cohort in Korea #MMPMID28549070
Lee MJ; Park JT; Han SH; Kim YL; Kim YS; Yang CW; Kim NH; Kang SW; Kim HJ; Yoo TH
PLoS One 2017[]; 12 (5): ä PMID28549070show ga
Background: The atherogenic index of plasma (AIP), which is the logarithmic ratio of triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C), had a linear relationship with clinical outcomes in the general population. However, the association of each lipid profile, TG and HDL-C, with survival was not straightforward in dialysis patients. This non-linear association led us to further investigate the prognostic impact of the AIP in these patients. Methods: From a nationwide prospective cohort, 1,174 incident dialysis patients were included. Patients were categorized into quintiles according to the AIP. An independent association of the AIP with all-cause and cardiovascular mortality was determined. Results: During a mean follow-up duration of 33.2 months, 170 patients (14.5%) died, and cardiovascular death was observed in 55 patients (4.7%). Multivariate Cox analyses revealed that the lowest (quintile 1, hazard ratio [HR] = 1.76, 95% confidence interval [CI] = 1.02?3.03) and the highest (quintile 5, HR = 2.15, 95% CI = 1.26?3.65) AIP groups were significantly associated with higher all-cause mortality compared to patients in quintile 3 (reference group). In terms of cardiovascular mortality, only the highest AIP group (quintile 5, HR = 2.59, 95% CI = 1.06?6.34) was significantly associated with increased risk of mortality. Sensitivity analyses showed that a U-shaped association between the AIP and all-cause mortality remained significant in non-diabetic and underweight to normal body mass index patients. Conclusions: Both the highest and the lowest AIP groups were independently associated with all-cause mortality, showing a U-shaped association. It suggested further studies are needed to identify targets and subgroups that can benefit from intervention of the AIP in incident dialysis patients.