Association of the Triglyceride–Glucose Index with Contrast-Associated Acute Kidney Injury in Patients with Atherosclerotic Renal Artery Stenosis

Contrast-associated acute kidney injury (CA-AKI) is an important complication of renal angiography in patients with atherosclerotic renal artery stenosis (RAS). We investigated the associations of the triglyceride–glucose (TyG) index, atherogenic coefficient (AC) and lipoprotein combined index (LCI) with CA-AKI in this population. This retrospective single-center study included 147 consecutive patients with atherosclerotic RAS undergoing renal angiography with or without renal artery intervention. CA-AKI was defined using a creatinine-based definition based on serum creatinine changes within 48–72 h after contrast exposure. Continuous variables were retained in their continuous form in the primary logistic regression analyses, and separate multivariable models were constructed for the TyG index, AC, and LCI, each adjusted for chronic kidney disease (CKD), left ventricular ejection fraction (LVEF), and contrast volume. Firth penalized logistic regression was performed as a sensitivity analysis. CA-AKI occurred in 22 patients (15.0%). In the adjusted model, a higher TyG index was associated with increased odds of CA-AKI (OR 4.263 per 1-unit increase, 95% CI 1.120–16.228; p = 0.034), whereas AC (OR 1.581, 95% CI 0.891–2.807; p = 0.118) and LCI (OR 1.047 per 10,000-unit increase, 95% CI 0.966–1.136; p = 0.264) were not significantly associated with CA-AKI. The association of the TyG index with CA-AKI remained significant in Firth penalized logistic regression (OR 3.48, 95% CI 1.17–14.33; p = 0.020). Higher contrast volume and lower LVEF were consistently associated with CA-AKI across the multivariable models. These findings suggest that the TyG index is associated with susceptibility to CA-AKI in patients with atherosclerotic RAS, although prospective validation is required before clinical application.