Abstract

Triglyceride-glucose (TyG) index is an emerging marker of adverse cardiometabolic conditions such as cardiovascular disease and type 2 diabetes. The long-term relevance of TyG index to chronic kidney disease (CKD) is uncertain. We aimed to assess the association of TyG index with CKD risk and its utility in risk prediction in a prospective study. The TyG index was calculated using fasting triglycerides and fasting plasma glucose (FPG) levels measured in 2362 men aged 42–61 years with normal kidney function using the formula: Ln (fasting triglycerides [mg/dL] × FPG [mg/dL]/2). Multivariable adjusted hazard ratios (HRs) (95% confidence intervals, CIs) were estimated for CKD. Correction for within-person variability was made using data from repeat measurements of triglycerides and FPG taken 11 years after baseline. Over a median follow-up duration of 17.5 years, 223 CKD cases were recorded. The age-adjusted regression dilution ratio for the TyG index was 0.54 (95% CI, 0.48–0.60). The risk of CKD increased continuously with increasing TyG index across the range 9.3 to 11.6 (p value for nonlinearity<.001). In analysis adjusted for established risk factors, a unit higher TyG index was associated with an increased risk of CKD (HR 1.59, 95% CI 1.24–2.05). Comparing extreme tertiles of the TyG index, the corresponding adjusted HR (95% CI) for CKD was 1.61 (1.15–2.27). Addition of the TyG index to a CKD risk prediction model containing established risk factors improved risk discrimination and reclassification (p value for difference in −2 log likelihood<.001; NRI=47.66%, p=.014; IDI=0.0164, p<.001). Higher TyG index is associated with an increased risk of CKD and improves the prediction and classification of CKD beyond established risk factors. Using single baseline estimations of the TyG index to investigate its association with CKD risk could considerably under-estimate the true association.

中文翻译：

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基线和平常甘油三酯-葡萄糖指数与慢性肾病的风险：一项前瞻性队列研究

摘要

甘油三酯-葡萄糖 (TyG) 指数是心血管疾病和 2 型糖尿病等不良心脏代谢状况的新兴标志物。TyG 指数与慢性肾脏病 (CKD) 的长期相关性尚不确定。我们的目的是在一项前瞻性研究中评估 TyG 指数与 CKD 风险的关联及其在风险预测中的效用。TyG 指数是根据 2362 名 42-61 岁、肾功能正常的男性测量的空腹甘油三酯和空腹血糖 (FPG) 水平计算得出的，公式为：Ln（空腹甘油三酯 [mg/dL] × FPG [mg/dL]/ 2）。估计 CKD 的多变量调整风险比 (HR)（95% 置信区间，CI）。使用基线后 11 年重复测量甘油三酯和 FPG 的数据对人内变异进行校正。在中位随访时间 17.5 年中，记录了 223 例 CKD 病例。TyG 指数的年龄调整回归稀释率为 0.54（95% CI，0.48-0.60）。随着 TyG 指数在 9.3 至 11.6 范围内的增加，CKD 风险持续增加（非线性p值<.001）。在根据既定风险因素进行调整的分析中，TyG 指数每升高一个单位，与 CKD 风险增加相关（HR 1.59，95% CI 1.24-2.05）。比较 TyG 指数的极端三分位数，CKD 的相应调整 HR (95% CI) 为 1.61 (1.15–2.27)。将 TyG 指数添加到包含既定风险因素的 CKD 风险预测模型中，可改善风险辨别和重新分类（-2 log 似然差异的p值 <.001；NRI=47.66%， p =.014；IDI=0.0164，p < .001）。较高的 TyG 指数与 CKD 风险增加相关，并可改善 CKD 的预测和分类，超越既定的风险因素。使用 TyG 指数的单一基线估计来调查其与 CKD 风险的关联可能会大大低估真实的关联。