The TyG Index Mediates Air-Pollution-Associated Chronic Kidney Disease Incidence in HIV/AIDS Patients: A 20-Year Cohort Study

Ambient air pollutants (APs) are associated with increased chronic kidney disease (CKD) risk in general populations, but their renal impact on HIV/AIDS patients remains understudied. This dynamic cohort included 7981 HIV/AIDS patients without baseline kidney disease from Wuhan and Zhenjiang, followed every 6 months with fasting blood tests to assess the triglyceride-glucose (TyG) index and estimated glomerular filtration rate (eGFR). Monthly average exposures to six APs were estimated from geocoded residential addresses. Modified Poisson regression models were used to assess associations between cumulative AP exposure and CKD incidence, with mediation analysis conducted to explore the potential role of the TyG index. Weighted quantile sum regression was applied to evaluate the joint effects of six APs. During the follow-up period, 168 new cases of CKD were identified. Each interquartile range increase in PM_2.5, PM₁₀, and SO₂ corresponded to a 16.5%, 18.9%, and 9.7% higher CKD risk, respectively, with the TyG index mediating 10.21%, 9.16%, and 5.14% of these associations. PM_2.5 demonstrated the highest attribution weight (44.4%) for CKD risk elevation in mixed-exposure models. Chronic ambient AP exposure, particularly PM_2.5, synergistically elevates CKD risk in HIV/AIDS patients with glucolipid dysregulation potentially being involved, necessitating targeted air quality policies to mitigate AP impacts on this vulnerable population.