{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T08:47:35Z","timestamp":1785833255986,"version":"3.56.0"},"reference-count":37,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002767","name":"Department of Science and Technology of Hunan Province","doi-asserted-by":"publisher","award":["2025JJ60550"],"award-info":[{"award-number":["2025JJ60550"]}],"id":[{"id":"10.13039\/501100002767","id-type":"DOI","asserted-by":"publisher"}]},{"award":["2025JJ60550"],"award-info":[{"award-number":["2025JJ60550"]}],"id":[{"id":"https:\/\/ror.org\/04qgr7x96","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Second Xiangya Hospital","award":["QH20230223"],"award-info":[{"award-number":["QH20230223"]}]},{"award":["QH20230223"],"award-info":[{"award-number":["QH20230223"]}],"id":[{"id":"https:\/\/ror.org\/053v2gh09","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Hunan Provincial Health Commission","award":["WZ2020-3"],"award-info":[{"award-number":["WZ2020-3"]}]},{"award":["WZ2020-3"],"award-info":[{"award-number":["WZ2020-3"]}],"id":[{"id":"https:\/\/ror.org\/04nm1xm49","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Cardiovascular\u2013kidney\u2013metabolic (CKM) syndrome, characterized by disturbances in glucose and lipid metabolism as its core pathophysiological feature, is a major driver of target organ damage. While early risk stratification in CKM stages 0\u20133 is critical to intercept renal decline, the practical utility of accessible metabolic surrogates remains poorly characterized. This study evaluated and compared the prospective capacity of the atherogenic index of plasma (AIP), triglyceride-glucose (TyG) index, and C-reactive protein\u2013triglyceride glucose index (CTI) for predicting renal deterioration in early-stage CKM. Methods: Data were extracted from the China Health and Retirement Longitudinal Study (2011\u20132015). In total, 4064 participants aged \u2265 45 with CKM stages 0\u20133 (with exclusion of participants with baseline CKM stage 4) were prospectively followed. Renal function decline was defined as an estimated glomerular filtration rate (eGFR) decrease of \u226530% over 4 years, calculated using the CKD-EPI 2012 cystatin C equation. Multivariable logistic regression, restricted cubic splines (RCSs), and receiver operating characteristic (ROC) curves were applied. Results: Overall, 122 participants developed the renal outcome. In fully adjusted models, AIP, TyG, and CTI were valid independent risk factors for renal decline, with the lipid-driven AIP exhibiting the strongest association (OR = 5.54, 95% CI: 3.30\u20139.29; TyG: OR = 1.97, 95% CI: 1.49\u20132.59; CTI: OR = 1.63, 95% CI: 1.30\u20132.05; all p &lt; 0.001). RCS analysis demonstrated significant non-linear dose\u2013response trajectories, with renal risk escalating sharply past specific exploratory inflection points (AIP = 0.97, TyG = 7.80, CTI = 8.07). ROC curves confirmed robust predictive performance (AUCs &gt; 0.75), with AIP performing optimally (AUC = 0.773). Conclusions: AIP, TyG, and CTI are independent longitudinal predictors of renal decline in early-stage CKM, with AIP demonstrating superior discriminatory power. Monitoring these composite indices and maintaining them within observed metabolic ranges may aid in early renal risk stratification and monitoring, though the exploratory statistical inflection points identified require validation in independent cohorts before clinical application.<\/jats:p>","DOI":"10.3390\/jcm15156055","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T08:02:19Z","timestamp":1785830539000},"page":"6055","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Metabolic Indices of Atherogenicity, Insulin Resistance, and Inflammation (AIP, TyG, and CTI) and the Risk of Renal Function Decline in Early-Stage CKM Syndrome: A Nationwide Prospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Shixin","family":"Yan","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China"},{"name":"Clinical Center for Gene Diagnosis and Therapy, The Second Xiangya Hospital, Central South University, Changsha 410011, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3552-6593","authenticated-orcid":false,"given":"Haiyang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, The Second Xiangya Hospital, Central South University, Changsha 410011, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1161\/CIR.0000000000001186","article-title":"A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A Scientific Statement From the American Heart Association","volume":"148","author":"Ndumele","year":"2023","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1572","DOI":"10.1681\/ASN.0000000658","article-title":"Global Burden of the Key Components of Cardiovascular-Kidney-Metabolic Syndrome","volume":"36","author":"Xie","year":"2025","journal-title":"J. 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