Relationship of atherogenic plasma index (logtriglycerid/HDL) with cariovascular diseases in hemodialysis patients

Objective: Although the association between dyslipidaemia and cardiovascular events is well established in the general population, the evidence is controversial in dialysis patients. In this study, we aimed to evaluate the association of atherogenic plasma index [log (TG/HDL-C) ratio] with cardiovascular diseases in hemodialysis patients. Methods: A retrospective study was performed in a total of 150 patients aged ≥18 years undergoing routine haemodialysis at Necmettin Erbakan University Faculty of Medicine and Konya City Hospital Haemodialysis Unit. Patients using antihyperlipidaemic agents were excluded from the study. Data were obtained by scanning hospital automation systems and patient files. Results: Among the patients included in our study, 57.30% (n=86) were male. The mean age of all patients was 51.84±17.48 years, mean BMI was 24.28 ± 4.56 kg/m2, and mean haemodialysis duration was 56.61 ± 49.62 months. Smoking was reported by 48.7% (n=73) of the patients. Hypertension was present in 74.7% (n=112), diabetes mellitus in 27.3% (n=41), and coronary artery disease in 13.3% (n=20). The rate of cardiovascular disease was 25.3% (n=38). The mean HDL was 40.16 ± 13.07 mg/dl, mean TG was 147.92 ± 75.22 mg/dl, and mean AIP index was 0.17 ± 0.30. A statistically significant difference was found in the distribution of body mass index groups according to sex (p=0.035). This difference was due to the fact that the rate of overweight patients (BMI=≥25.0-29.9 kg/m 2) was lower in males than in females. The rate of smoking was significantly lower in women than in men (p<0.001). HDL and total cholesterol levels were found to be statistically significantly higher in female patients than in male patients (p values; p=0,012; p=0,025, respectively). A statistically significant difference was found in the distribution of AIP index levels according to BMI groups (p=0,046). This difference was due to the fact that AIP index levels were lower in the patient group with a BMI <18.5 kg/m2 than in the patient group with a BMI ≥30.0 kg/m2 (p<0.05). AIP level was found to be statistically significantly higher in smoking patients than in non-smoking patients (p<0.001). Among the blood lipid parameters, HDL and triglyceride levels were higher in patients with cardiovascular disease compared to patients without cardiovascular disease. However, no statistically significant difference was found (p>0.05). In our study, patients were divided into three groups according to AIP index levels (AIP <0.11; low risk, 0.11-0.21; moderate risk,>0.21; high risk). 60 patients had AIP index level <0.11, 23 patients had AIP index level between 0.11-0.21 and 67 patients had AIP index level>0.21. 38 patients were found to have had a cardiovascular disease and 17 of them were in the low-risk group, 4 in the intermediate-risk group and 17 in the high-risk group according to the AIP index. In other words, haemodialysis patients who had cardiovascular disease according to the AIP index showed a U-shaped distribution. However, this was not statistically significant. Conclusion: Although AIP is a simple, reproducible and low-cost parameter that may be an indicator of cardiovascular diseases, further studies are needed to utilise this biomarker in HD patients. Therefore, it is vital that future studies focus on identifying risk factors specific to HD patients and decipher the underlying mechanisms responsible for poor outcomes in these patients.