Estimate of reduced glomerular filtration rate by triglyceride-glucose index: insights from a general Chinese population

ABSTRACT

Objectives: Recent studies have identified triglyceride-glucose index (TyG) as a surrogate of insulin resistance. Since insulin resistance correlates with renal damage, our study aims to investigate the impact of TyG on the risk of reduced eGFR and explore its value to improve the risk stratification and prevention of reduced eGFR.

Methods: This cross-sectional study included 6466 participants (mean age:59.57 years, 60.2% females) from rural areas of northeast China between September 2017 to May 2018. TyG was calculated as ln[fasting triglyceride (mg/dL)×fasting plasma glucose (mg/dL)/2]. Reduced eGFR was defined as eGFR<60ml/min per 1.73m².

Results: The prevalence of reduced eGFR was 2.94%. After full adjustment, each SD increase of TyG caused 42.6% additional risk for reduced eGFR. When dividing TyG into quartiles, the top quartile had a 1.934 times risk than the bottom quartile. Furthermore, the risk of reduced eGFR increased linearly with the increment of TyG. Subgroup analysis also revealed the association was robust to several risk factors of renal damage. Finally, category-free net reclassification index (0.204, 95% CI: 0.060–0.349, p = 0.005) and integrated discrimination index (0.010, 95% CI: 0.005–0.016, p < 0.001) demonstrated the value of TyG to refine the risk stratification of reduced eGFR.

Conclusion: Our work reveals the robust association between TyG and reduced eGFR. Moreover, the present study implicates the potential role of TyG as a risk indicator to optimize the prevention of reduced eGFR. Lastly, the findings also suggest the importance of simultaneous glycemic and lipid control to avoid the development and progression of reduced eGFR.

KEYWORDS:

• Dyslipidemia
• hyperglycemia
• insulin resistance
• reduced eGFR
• triglyceride-glucose index

Availability of data and materials

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

Authors’ contributions

LX was responsible for the concept and design of the study. SL, LJ and WS were responsible for the study coordination and conduct. WS contributed to the drafting of the manuscript. LJ, YT and WS collected and analyzed the data. WS, LJ interpreted the data. All authors read and approved the final manuscript.

Ethics approval and consent to participate

The study was approved by the Central Ethics Committee at the China National Center for Cardiovascular Disease. Written informed consent was obtained from all participants.

Acknowledgments

The authors would like to thank neurologists and staff from the central hospital and CDC of Chaoyang, Liaoyang, Dandong and Donggang city in Liaoning province who work hard to ensure the reliability and accuracy of data. The authors thank Dr Loic Desquilbet and Dr Guowei Pan for providing the SAS macro for restricted cubic spline analysis.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial relationships to disclose.

Additional information

Funding

This study was supported by the Department of Science and Technology of Liaoning Province (2018225065) and the National Key R&D Program of China (2017YFC1310902).