The atherogenic index of plasma and the risk of mortality in incident dialysis patients: Results from a nationwide prospective cohort in Korea

Mi Jung Lee, Jung Tak Park, Seung Hyeok Han, Yong Lim Kim, Yon Su Kim, Chul Woo Yang, Nam Ho Kim, Shin Wook Kang, Hyung Jong Kim, Tae Hyun Yoo

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21 Citations (Scopus)


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.

Original languageEnglish
Article numbere0177499
JournalPloS one
Issue number5
Publication statusPublished - 2017 May

Bibliographical note

Funding Information:
This work was supported by the Brain Korea 21 PLUS Project for Medical Science, Yonsei University, by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (No. NRF-2011-0030711), and by a grant of the Korea Healthcare Technology R&D Project through the Korean Health IndustryDevelopment Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HC15C1129). Clinical research center for end- stage renal disease received the funding, and the leader of the center is YLK. The "Ministry of Health and Welfare" URL is: The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
© 2017 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General


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