Shang Zhi, Feng Song-Tao, Qian Hui, Deng Zhen-Ling, Wang Yue, Gao Yue-Ming
Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China.
Department of Nephrology, Jiangsu University Affiliated People's Hospital, Jiangsu, China.
Ren Fail. 2025 Dec;47(1):2446656. doi: 10.1080/0886022X.2024.2446656. Epub 2025 Jan 5.
The triglyceride-glucose (TyG) index has emerged as a credible surrogate indicator of insulin resistance in recent years. This study aimed to investigate the relationship between the TyG index and the deterioration of kidney function in patients with cardiovascular-kidney-metabolic (CKM) syndrome.
In this retrospective cohort study from China, 27,407 hospitalized patients with stage 1-4 CKM syndrome were consecutively included. The participants were categorized into four groups according to TyG index quartiles. The study outcome was the deterioration of kidney function, defined as a decrease in estimated glomerular filtration rate (eGFR) ≥ 40% from baseline. Restricted cubic spline (RCS) curves and multivariate Cox analysis were used for analysis.
3,248 outcome events were recorded during a mean follow-up period of 34 months. The RCS plot displayed a U-shaped curve between the baseline TyG index and the deterioration of kidney function ( for non-linear < 0.001). The baseline TyG index with the lowest hazard ratio (HR) of eGFR decline ranges from 8.65 to 9.15, with an inflection point at 8.88. After fully adjusting for covariates, HRs and 95% confidence intervals (CIs) from the lowest to highest TyG index quartile were 1.00 (reference), 0.82 (0.74, 0.91), 0.78 (0.70, 0.86), and 0.93 (0.83, 1.03), respectively. According to the Kaplan-Meier survival curve, the risk of deterioration of kidney function was elevated in the lowest and highest TyG index quartiles (log-rank test, 0.0001).
In individuals with CKM syndrome, a non-linear U-shaped relationship existed between the baseline TyG index and the deterioration of kidney function.
近年来，甘油三酯-葡萄糖（TyG）指数已成为胰岛素抵抗的可靠替代指标。本研究旨在探讨TyG指数与心血管-肾脏-代谢（CKM）综合征患者肾功能恶化之间的关系。
在这项来自中国的回顾性队列研究中，连续纳入了27407例1-4期CKM综合征住院患者。参与者根据TyG指数四分位数分为四组。研究结局为肾功能恶化，定义为估计肾小球滤过率（eGFR）较基线下降≥40%。采用限制立方样条（RCS）曲线和多变量Cox分析进行分析。
在平均34个月的随访期内记录到3248例结局事件。RCS图显示基线TyG指数与肾功能恶化之间呈U形曲线（非线性<0.001）。eGFR下降风险比（HR）最低的基线TyG指数范围为8.65至9.15，拐点为8.88。在对协变量进行充分调整后，TyG指数四分位数从最低到最高的HR及95%置信区间（CI）分别为1.00（参考值）、0.82（0.74，0.91）、0.78（0.70，0.86）和0.93（0.83，1.03）。根据Kaplan-Meier生存曲线，TyG指数最低和最高四分位数组肾功能恶化风险升高（对数秩检验，<0.0001）。
在CKM综合征患者中，基线TyG指数与肾功能恶化之间存在非线性U形关系。
