The Triglyceride-Glucose Index and Obesity-Related Risk of End-Stage Kidney Disease in Austrian Adults

Fritz, Josef; Brozek, Wolfgang; Concin, Hans; Nagel, Gabriële; Kerschbaum, Julia; Lhotta, Karl; Ulmer, Hanno; Zitt, Emanuel

doi:10.1001/jamanetworkopen.2021.2612

Cited by 43 publications

(42 citation statements)

References 49 publications

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“…In addition, a large number of studies have shown that the TyG index is closely related to vascular calcification [ 41 – 43 ], and arterial stiffness assessed by pulse wave velocity [ 44 , 45 ], both of which were important risk predictors for ASCVD. Moreover, the association between the TyG index and a variety of risk factors for ASCVD, for example, hypertension [ 46 ], renal dysfunction [ 47 ], and hyperuricemia [ 48 ], was also confirmed by previous studies. As for other IR surrogates, however, the corresponding evidence was relatively lacking, which may be another important explanation for the superiority of the TyG index.…”

Section: Discussionmentioning

confidence: 59%

Comparison of various insulin resistance surrogates on prognostic prediction and stratification following percutaneous coronary intervention in patients with and without type 2 diabetes mellitus

Zhao

Cheng

et al. 2021

Cardiovasc Diabetol

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Background Insulin resistance (IR), evaluation of which is difficult and complex, is closely associated with cardiovascular disease. Recently, various IR surrogates have been proposed and proved to be highly correlated with IR assessed by the gold standard. It remains indistinct whether different IR surrogates perform equivalently on prognostic prediction and stratification following percutaneous coronary intervention (PCI) in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with and without type 2 diabetes mellitus (T2DM). Methods The present study recruited patients who were diagnosed with NSTE-ACS and successfully underwent PCI. IR surrogates evaluated in the current study included triglyceride-glucose (TyG) index, visceral adiposity index, Chinese visceral adiposity index, lipid accumulation product, and triglyceride-to-high density lipoprotein cholesterol ratio, calculations of which were conformed to previous studies. The observational endpoint was defined as the major adverse cardiovascular and cerebrovascular events (MACCE), including cardiac death, non-fatal myocardial infarction, and non-fatal ischemic stroke. Results 2107 patients (60.02 ± 9.03 years, 28.0% female) were ultimately enrolled in the present study. A total of 187 (8.9%) MACCEs were documented during the 24-month follow-up. Despite regarding the lower median as reference [hazard ratio (HR) 3.805, 95% confidence interval (CI) 2.581–5.608, P < 0.001] or evaluating 1 normalized unit increase (HR 1.847, 95% CI 1.564–2.181, P < 0.001), the TyG index remained the strongest risk predictor for MACCE, independent of confounding factors. The TyG index showed the most powerful diagnostic value for MACCE with the highest area under the receiver operating characteristic curve of 0.715. The addition of the TyG index, compared with other IR surrogates, exhibited the maximum enhancement on risk stratification for MACCE on the basis of a baseline model (Harrell’s C-index: 0.708 for baseline model vs. 0.758 for baseline model + TyG index, P < 0.001; continuous net reclassification improvement: 0.255, P < 0.001; integrated discrimination improvement: 0.033, P < 0.001). The results were consistent in subgroup analysis where similar analyses were performed in patients with and without T2DM, respectively. Conclusion The TyG index, which is most strongly associated with the risk of MACCE, can be served as the most valuable IR surrogate for risk prediction and stratification in NSTE-ACS patients receiving PCI, with and without T2DM.

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Section: Discussionmentioning

confidence: 59%

Comparison of various insulin resistance surrogates on prognostic prediction and stratification following percutaneous coronary intervention in patients with and without type 2 diabetes mellitus

Zhao

Cheng

et al. 2021

Cardiovasc Diabetol

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“…The estimated filtration rate (eGFR) was determined using the Modification of Diet in Renal Disease Study equation (male: eGFR = 186 × SCr −1.154 × year −0.203 ; female: eGFR = 186 × SCr −1.154 × year −0.203 × 0.724). 19 The TyG Index was calculated as: ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2].…”

Section: Data Collection and Measurementsmentioning

confidence: 99%

“…18 For decades, the TyG Index has been recognized as a surrogate marker of IR. 16 Recent studies have shown that the TyG Index is a new predictor of T2DM 19 and cardiovascular disease. 20 In Australia, one study enrolled 176,420 individuals (body mass index (BMI) = 20.6-29.2 kg/m 2 ) and investigated the correlation between the TyG Index and ESRD.…”

Section: Introductionmentioning

confidence: 99%

Relationship Between the TyG Index and Diabetic Kidney Disease in Patients with Type-2 Diabetes Mellitus

Lv¹,

Zhou²,

Chen³

et al. 2021

DMSO

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Background: Diabetic kidney disease (DKD) lacks a simple and relatively accurate predictor. The Triglyceride-Glucose (TyG) Index is a proxy of insulin resistance, but the association between the TyG Index and DKD is less certain. We investigated if the TyG Index can predict DKD onset effectively. Materials and Methods: Cross-sectional and longitudinal analyses were undertaken. In total, 1432 type-2 diabetes mellitus (T2DM) patients were included in the cross-sectional analysis. The TyG Index (calculated by ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]) was split into three tertiles. Associations of the TyG Index with microalbuminuria and estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m 2 were calculated. Longitudinally, 424 patients without DKD at baseline were followed up for 21 (range, 12-24) months. The main outcome was DKD prevalence as defined with eGFR <60 mL/min/ 1.73 m 2 or continuously increased urinary microalbuminuria: creatinine ratio (>30 mg/mL) over 3 months. Cox regression was used to analyze the association between the TyG Index at baseline and DKD. Receiver operating characteristics curve (ROC) analysis was used to assess the sensitivity and specificity of the TyG Index in predicting DKD. Results: In cross-sectional analysis, patients with a higher TyG Index had a higher risk of microalbuminuria (OR = 2.342, 95% CI = 1.744-3.144, p < 0.001), and eGFR <60 mL/min/ 1.73 m 2 (1.696, 95% CI =1.096-2.625, p = 0.018). Longitudinally, 94 of 424 participants developed DKD. After confounder adjustment, patients in the high tertile of the TyG Index at baseline had a greater risk to developing DKD than those in the low tertile (HR = 1.727, 95% CI = 1.042-2.863, p = 0.034). The area under the ROC curve was 0.69 (0.63-0.76). Conclusion:The TyG Index is a potential predictor for DKD in T2DM patients. Clinical Trial: Clinical Trials identification number = NCT03692884.

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“…Individuals who are obese have a more than 3-fold higher risk of developing end-stage kidney disease (ESKD) than those with normal bodyweight [74,75]. In a large cohort from Austria, with a prevalence of obesity of 11.8%, 0.3% developed ESKD in a follow-up of 22 years and an increase of 5 points of BMI increased the risk by 56% [76]. In a cohort of the Kaiser Permanent register with 320,252 subjects followed over 21 years, the hazard risk for ESKD increased through the obesity grade 3.57, 6.10, and 7.07 for obesity 1 to III respectively, as compared with normal weight subjects [74].…”

Section: Progression To Ckd and Esrdmentioning

confidence: 99%

Impact of Obesity in Kidney Diseases

et al. 2021

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The clinical consequences of obesity on the kidneys, with or without metabolic abnormalities, involve both renal function and structures. The mechanisms linking obesity and renal damage are well understood, including several effector mechanisms with interconnected pathways. Higher prevalence of urinary albumin excretion, sub-nephrotic syndrome, nephrolithiasis, increased risk of developing CKD, and progression to ESKD have been identified as being associated with obesity and having a relevant clinical impact. Moreover, renal replacement therapy and kidney transplantation are also influenced by obesity. Losing weight is key in limiting the impact that obesity produces on the kidneys by reducing albuminuria/proteinuria, declining rate of eGFR deterioration, delaying the development of CKD and ESKD, and improving the outcome of a renal transplant. Weight reduction may also contribute to appropriate control of cardiometabolic risk factors such as hypertension, metabolic syndrome, diabetes, and dyslipidemia which may be protective not only in renal damage but also cardiovascular disease. Lifestyle changes, some drugs, and bariatric surgery have demonstrated the benefits.

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The Triglyceride-Glucose Index and Obesity-Related Risk of End-Stage Kidney Disease in Austrian Adults

Cited by 43 publications

References 49 publications

Comparison of various insulin resistance surrogates on prognostic prediction and stratification following percutaneous coronary intervention in patients with and without type 2 diabetes mellitus

Comparison of various insulin resistance surrogates on prognostic prediction and stratification following percutaneous coronary intervention in patients with and without type 2 diabetes mellitus

Relationship Between the TyG Index and Diabetic Kidney Disease in Patients with Type-2 Diabetes Mellitus

Impact of Obesity in Kidney Diseases

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