BACKGROUND: The effects of atherogenic indices on kidney function remain unclear. This study evaluated the association between atherogenic indices and risk of chronic kidney disease (CKD) in adults with metabolic derangements. METHODS: A total of 4,176 participants from the Gangnam Severance Medical Cohort (2006-2021), which consisted of participants who had at least one disease related to metabolic derangements including diabetes mellitus, fatty liver, and hypertension were enrolled and atherogenic indices (lipid ratios including atherogenic index of plasma [AIP]) were assessed. The study endpoint was a composite kidney outcome (estimated glomerular filtration rate [eGFR] of <
60 mL/min/1.73 m2 in at least two measurements in participants with baseline eGFR of ≥60 mL/min/1.73 m2
≥30% decrease in eGFR from baseline in participants with baseline eGFR of <
60 mL/min/1.73 m2
or the initiation of dialysis or kidney transplantation). RESULTS: During a median follow-up of 6.0 years (interquartile range, 2.5-11.0 years), 1,266 composite kidney outcomes (30.3%) occurred. The highest quartile of AIP showed a higher risk of composite kidney outcome than the lowest quartile (hazard ratio [HR], 1.31
95% confidence interval [CI], 1.12-1.54). This association was consistent when the AIP was treated as a continuous variable (HR per 1.0 increase, 1.51
95% CI, 1.21-1.88). However, other atherogenic indices did not show significant associations with composite kidney outcome. Adding AIP to the traditional risk model to predict composite kidney outcomes significantly improved the C-index, net reclassification index, and integrated discrimination improvement. The association between high AIP and an increased risk of composite kidney outcome was consistent regardless of subgroup. CONCLUSION: High AIP was associated with an increased risk of CKD in adults with metabolic derangements.