The association between the advanced lung cancer inflammation index and carotid plaque in non-dialysis CKD stage 3–5 patients: a cross-sectional study

Atherosclerosis and arterial plaque are common and severe complications in patients with chronic kidney disease (CKD), particularly in advanced stages (CKD 3–5). Identifying reliable predictors for cardiovascular risk in this population is crucial. The Advanced Lung Cancer Inflammation Index (ALI), a marker that integrates body mass index (BMI), albumin, and the neutrophil-to-lymphocyte ratio (NLR), has shown promise as a predictor of inflammation and nutritional status. However, its association with carotid plaque in non-dialysis CKD patients remains unexplored. This retrospective cross-sectional study included 204 non-dialysis CKD stage 3–5 patients admitted between April and July 2019. ALI was calculated as BMI × albumin/NLR, and carotid plaque was assessed using ultrasound. Multivariable logistic regression models were employed to evaluate the association between logarithm-transformed ALI (LnALI) and carotid plaque, adjusting for relevant covariates. Restricted cubic spline (RCS) analyses were conducted to assess the potential non-linear relationship between ALI and carotid plaque formation. Patients with carotid plaques were older (67 [57–74] vs. 51 [40–61] years, P < 0.001) and had a higher prevalence of diabetes mellitus (51.2% vs. 19.2%, P < 0.001) and cardiovascular disease (35.7% vs. 12.5%, P < 0.001). LnALI was inversely associated with carotid plaque (OR: 0.29, 95% CI: 0.13–0.66, P = 0.003). Patients in the highest ALI quartile had a significantly lower risk of carotid plaques compared to those in the lowest quartile (OR: 0.17, 95% CI: 0.05–0.58, P = 0.005). RCS analysis did not detect a significant non-linear association between LnALI and carotid plaque. (P for non-linearity = 0.828). ALI was significantly and inversely associated with carotid plaque in non-dialysis CKD stage 3–5 patients. As an index integrating inflammatory and nutritional components, ALI may reflect the overall cardiometabolic status of this population. Prospective studies are needed to determine its value for cardiovascular risk stratification in clinical practice.