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Triglyceride-glucose index is associated with the risk of chronic kidney disease progression in type 2 diabetes

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Abstract

Objective

The study aimed to investigate the association of TyG index with chronic kidney disease (CKD) progression in type 2 diabetes mellitus (T2DM).

Methods

A total of 179 T2DM patients with CKD were retrospectively included. CKD progression was defined as a doubling of baseline serum creatinine or onset of end-stage kidney disease (ESKD). Internal validation was performed by the Kidney Failure Risk Equation (KFRE) model and Net reclassification improvement (NRI).

Results

The optimal cut-off value of the TyG index was 9.17. The cumulative incidence of kidney outcomes was significantly higher in the high-TyG group (v.s low-TyG group, P = 0.019). In addition, the high-TyG index was associated with a greater risk of CKD progression (HR 1.794, 95% CI 1.026–3.137, P = 0.040). And reclassification analyses confirmed the final adjusted model improved NRI (61.90% v.s model 2, 43.80% v.s model 1). The further RCS curves presented an inverted S-shaped relationship between the TyG index and the risk of CKD progression. Internal validation verified that a higher TyG index was associated with 2.10-fold increased odds of 2-year ESKD risk >10% (95% CI 1.82–8.21). Moreover, subgroup analysis suggested that the association was more pronounced in those at relatively early CKD stages (higher than stage 2) and with no medication history of oral hypoglycemic agents.

Conclusion

An elevated TyG index was associated with a higher risk of CKD progression in T2DM patients. Our findings suggested that timely targeting insulin sensitivity at the early stages of T2DM might be associated with declined future risk of CKD development.

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Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank the patients for participation in our study and the staffs of the Department of Nephrology at the First Affiliated Hospital of Nanjing Medical University for assistance.

Author information

Author notes

  1. These authors contributed equally: Suyan Duan, Meng Zhou, Fang Lu

  2. These authors jointly supervised this work: Bo Zhang, Changying Xing, Yanggang Yuan

Authors and Affiliations

  1. Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China

    Suyan Duan, Meng Zhou, Fang Lu, Chen Chen, Si Chen, Luhan Geng, Chengning Zhang, Honglei Guo, Ming Zeng, Bin Sun, Huijuan Mao, Bo Zhang, Changying Xing & Yanggang Yuan

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  1. Suyan Duan
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Contributions

S.D. designed the research and contributed to the writing. M.Z. and F.L. analyzed the data and performed statistical analysis. F.L., C.C., S.C., and L.G. conducted the research, C.Z., H.G., M.Z., B.S., and H.M. reviewed the paper. C.X. and B.Z. conceived, coordinated the study, and had responsibility for its final content. Y.Y. is the guarantor of this work, who had complete access to all the data in the study and takes ultimate responsibility for the study design and integrity of data analysis. All authors have read the final paper and approved the submission.

Funding

This work was supported by grants from the National Natural Science Foundation of China (82170699, 81870469 to Y.Y., No. 82100767 to S.D.), the Natural Science Foundation of Jiangsu Province (BK20191075 to S.D.), “PRO•Run” Fund of the Nephrology Group of CEBM (KYJ202206-0003-6 to Y.Y., KYS2021-03-02-14 to B.Z.), the “333 Project” of Jiangsu Province, the Six Talent Peaks Project in Jiangsu Province (WSN-010 to Y.Y.), “Yiluqihang·Shenmingyuanyang” medical development And Scientific Research Fund project on Kidney Diseases (SMYY20220301001 to Y.Y.), Project of clinical capability improvement of the First Affiliated Hospital of Nanjing Medical University (JSPH-MC-2021-14 to S.D.), Project of Bethune PuAi Medical Research Fund (PAYJ-058 to S.D.), Postgraduate Research & Practice Innovation Program of Jiangsu Province (JX10213856 to M.Z.), and the Priority Academic Program Development (PAPD) of Jiangsu Higher Education Institution.

Corresponding authors

Correspondence to Bo Zhang, Changying Xing or Yanggang Yuan.

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The authors declare no competing interests.

Ethics approval and consent to participate

All procedures and methods were performed in accordance with relevant guidelines and regulations. This study protocol was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Nanjing Medical University. Informed consent was obtained from all individual participants included in the study.

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Duan, S., Zhou, M., Lu, F. et al. Triglyceride-glucose index is associated with the risk of chronic kidney disease progression in type 2 diabetes. Endocrine 81, 77–89 (2023). https://doi.org/10.1007/s12020-023-03357-z

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