Association Between the aggregate index of systemic inflammation and CKD: Evidence from NHANES 1999-2018

Hang Wu ^* Dongli Huang

• Bishan hospital of Chongqing Medical University, Chongqing, China

We aimed to investigate the potential association between the aggregate index of systemic inflammation (AISI) and chronic kidney disease (CKD).This study analyzed data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018. CKD was defined as either an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m² or the presence of albuminuria, defined as a urine albumin-to-creatinine ratio (ACR) of 30 mg/g or higher. Low eGFR is an eGFR of less than 60 mL/min/1.73 m². Multivariate regression analysis, smoothed curve fitting, and subgroup analyses were conducted to investigate the relationship between the Inflammatory status index (AISI) and CKD. The Receiver Operating Characteristic (ROC) curve analysis was used to evaluate its ability to identify CKD and low eGFR. The AISI was transformed using the natural logarithm (Ln) for statistical analysis.Results: Of the 50,768 recruits, 49.86% were male. The prevalence of CKD and low eGFR was 17.82% and 8.57%, respectively.Ln-AISI was positively associated with CKD (OR = 1.29; 95% CI: 1.24, 1.34) and low eGFR (OR = 1.16; 95% CI: 1.10, 1.24). Smooth curve fitting revealed a positive association between AISI and CKD and low eGFR.Subgroup analysis and interaction tests indicated that stratifications did not significantly alter the association between AISI and CKD and low eGFR.Threshold effect analysis indicated that this relationship became more pronounced when Ln-AISI exceeded 5.2 (AISI＞181.27). The ROC analysis showed that AISI had better discrimination and accuracy for identifying CKD and low eGFR compared to other inflammatory indicators (lymphocyte count (LYM), systemic immune-inflammation index (SII), platelet-tolymphocyte ratio (PLR), and the product of platelet count and neutrophil count (PPN)).AISI was significantly and positively correlated with the prevalence of CKD, and this relationship was more potent when AISI was greater than 181.27. Compared with other inflammatory indicators, AISI was more effective in identifying CKD.