TM Shiva Ganesh, Vignessh Raveekumaran, Chandrasekar Kulli Thirugnanam, Sathiya Sai Kiruba Kennedy Babu
Chronic Kidney Disease (CKD) is a major and growing global health challenge affecting millions of individuals worldwide. Cardiovascular Disease (CVD) remains the leading cause of morbidity and mortality in patients with CKD, with atherosclerotic CVD contributing substantially to adverse outcomes. Traditional lipid parameters often fail to adequately capture the complex dyslipidaemia associated with CKD, resulting in underestimation of cardiovascular risk. In addition to elevated Triglycerides (TG) and reduced High-Density Lipoprotein Cholesterol (HDL-C), patients with CKD frequently exhibit increased levels of Lipoprotein(a) {Lp(a)}, an established independent risk factor for atherosclerosis and thrombosis. In recent years, several novel lipid indices derived from conventional lipid parameters and Lp(a) have emerged as potentially superior markers of atherogenic risk. These include the Atherogenic Index of Plasma (AIP), Castelli Risk Indices (CRI), Atherogenic Coefficient (AC), and Lipid Tetrad Index (LTI). Unlike isolated lipid measurements, these composite indices provide a more comprehensive assessment of the balance between atherogenic and protective lipoproteins and may better reflect the unique lipid abnormalities seen in CKD. Although growing evidence suggests that these indices are associated with cardiovascular risk and disease progression in CKD, the available literature remains fragmented, and their clinical utility has not been comprehensively synthesised. The novelty of the present review lies in its integrated evaluation of both Lp(a) and emerging lipid indices as cardiovascular risk assessment tools in CKD. By consolidating current evidence, highlighting pathophysiological links, and identifying existing research gaps, the present review aimed to provide a contemporary perspective on their potential role in improving cardiovascular risk stratification and guiding future research in CKD populations.