Atherogenic index of plasma is associated with poor prognosis in diabetic patients with acute kidney injury

Objective: To explore the correlation between atherogenic index of plasma (AIP) and all-cause death and renal non-recovery in diabetic patients with acute kidney injury (AKI). Methods: A retrospective analysis was conducted on the baseline and follow-up clinical data of diabetic patients with AKI in the First Affiliated Hospital of Guangxi Medical University from April 2010 to April 2025. The baseline AIP is calculated as log10 [TG (mg/dL)/HDL-C(mg/dL)]. Diabetic patients with AKI were divided into Q1, Q2, Q3, and Q4 groups based on the quartiles of baseline AIP. The differences in clinical data among different AIP groups were compared. The predictive value of AIP for all-cause death and non-recovery of renal function in diabetic patients with AKI was evaluated by drawing receiver operating characteristic (ROC) curves. The association between AIP and clinical outcomes in diabetic patients with AKI was analyzed using multivariable Cox regression and restricted cubic spline (RCS) regression. Result: A total of 1046 diabetic patients with AKI were enrolled, with a male to female ratio of 2:1. The average age was 62.40 ± 13.57 years. The average follow-up period was 101.13 ± 64.81 days. The all-cause mortality was 16.8%, and the rate of lack of renal recovery was 69.4%. The area under ROC curves for AIP in predicting all-cause death and lack of renal recovery in diabetic AKI patients were 0.805 and 0.782, respectively. The multivariate Cox and RCS regression analysis showed that after adjusting for confounding factors, the AIP level were non-linear associated with risk of all-cause death (HR = 5.427, 95%CI=2.999-9.821, inverted U-shape) and non-recovery of renal function (HR = 2.769, 95% CI = 2.085-3.677, S-shape) in diabetic patients with AKI. However, competing risk analysis revealed that after accounting for death as a competing event, AIP was no longer significantly associated with renal non-recovery (HR = 1.126, 95% CI: 0.864-1.467, P = 0.380). Conclusion: AIP is non-linearly associated with all-cause death in diabetic patients with AKI, and may serve as a useful biomarker for mortality risk stratification rather than for predicting renal recovery.