Triglyceride–Glucose Index May Predict Renal Survival in Patients with IgA Nephropathy

Abstract

Background: The triglyceride–glucose (TyG) index is a simple, novel and reliable surrogate marker of insulin resistance. However, evidence for the prognostic impact of an elevated TyG index on IgA nephropathy (IgAN) is limited. Therefore, we evaluated the relationship between the TyG index and the risk of renal progression in IgAN. Method: This cohort study involved biopsy-proven IgAN between January 2009 and December 2018 in West China Hospital, in which patients were assigned to two groups based on the cut-off value of TyG using receiver operating characteristic (ROC) curves. A 1:1 matched-pair analysis was established to optimize the bias in IgAN by propensity score matching (PSM). The TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. The composite endpoint was defined by eGFR decreased ≥50% of the baseline level, end-stage kidney disease (ESKD), renal transplantation and/or death. Univariable and multivariable Cox proportional hazard models were applied to confirm the predictive value of the optimal marker. Results: Before PSM, a total of 1210 participants were ultimately included. During a median follow-up period of 55.8 months (range 37.20–79.09 months), 129 participants progressed to the composite endpoint (10.7%). After PSM, 386 patients were enrolled in the matched cohort, of whom 34 (9.3%) patients reached the endpoints. Based on the cut-off value of the TyG index, patients were divided into the low TyG index group (TyG ≤ 8.72, n = 690) and the high TyG index group (TyG > 8.72, n = 520). Further analysis demonstrated that a higher TyG index was significantly associated with a higher risk of reaching composite endpoints in IgAN patients in both the unmatched and matched cohorts (before PSM: HR 2.509, 95% CI 1.396–4.511, p = 0.002; after PSM: HR 2.654, 95% CI 1.299–5.423, p = 0.007). Conclusion: A high TyG index is associated with a higher risk of renal progression.

Association between triglyceride-glucose index and risk of end-stage renal disease in patients with type 2 diabetes mellitus and chronic kidney disease

“…A major finding of our study was that an elevated TyG index, a surrogate marker of IR, is significantly associated with a higher risk of ESRD in individuals with T2DM and CKD. It was suggested that the TyG index appeared to be associated with incident CKD ( 21 – 24 , 40 ) and CKD progression ( 25 , 41 ) in patients with or without diabetes. Recently, Fritz et al.…”

The triglyceride-glucose index is associated with the risk of acute kidney injury in critically ill patients

“…The prevalence of IR is increasing rapidly worldwide due to the aging population, obesity, and physical inactivity [11] . Increasing evidence has shown that IR may act as a critical mechanism of renal damage [7,19] . Previous studies have found that IR existed in different stages of CKD, even in the early stage of mild renal function damage [7,20,21] .…”

“…Studies have shown that the TyG index was highly sensitive (96.5%) and speci c (85.0%) for the detection of IR, compared to the hyperinsulinemiceuglycemic clamp technique [12] . Furthermore, research has shown that the TyG index performed better than HOMA-IR for the estimation of IR [26] , and was associated with severe clinical pathological manifestations [19] .…”

Triglyceride glucose index and renal function decline in Han Chinese hypertensive patients

“…Several studies have investigated the association between the TyG index and renal damage in different populations 23–29 . However, there has been a limited focus on hypertensive cohorts 28,29 .…”