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Longitudinal triglyceride-glucose index trajectories and kidney outcomes in patients with metabolic
Jong Hyun Jhee1, Wooram Bae1, Hyo Jeong Kim1
1Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Background:
Triglyceride-glucose index (TyGi), a surrogate marker of metabolic dysfunction, has not been evaluated for kidney outcomes in patients with metabolic dysfunction-associated fatty liver disease (MAFLD). We aimed to evaluate this association in individuals with MAFLD.
Methods:
Totally 868 patients with MAFLD from the Gangnam Severance Medical Cohort (2006-2021) were included. TyGi trajectories were defined using latent class mixture modeling based on their longitudinal changes: decreasing (n = 426) vs. increasing (n = 442). MAFLD was diagnosed based on hepatic steatosis and at least one of the following: overweight or obese, type 2 diabetes, or two or more metabolic abnormalities. Kidney outcomes included: sustained reduction in eGFR to <60 mL/min/1.73 m2 for those with baseline eGFR of ≥60 mL/min/1.73 m2, ≥30% decline from baseline for those with eGFR <60 mL/min/1.73 m2, or initiation of dialysis or kidney transplantation. Cause-specific Cox proportional hazard models assessed the association between TyGi trajectories and kidney outcomes.
Results:
The participants' mean age was 52.3 ± 10.4 years and 504 (58.1%) were male. Over a median follow-up of 6.9 years (4.0- 10.0 years), 36 kidney outcome events occurred. The incidence rates were 4.02 and 9.06 per 1,000 person-years in the decreasing and increasing TyGi trajectory groups, respectively (p = 0.02). In a multivariable cause-specific Cox model, the increasing trajectory group had a significantly greater risk of kidney outcomes than the decreasing group (hazard ratio, 3.68; 95% confidence interval, 1.68- 8.05; p = 0.001). Subgroup analyses showed consistent findings.
Conclusion:
Increasing longitudinal TyGi levels are associated with a higher risk of adverse kidney outcomes in patients with MAFLD.
Insights
Increasing triglyceride-glucose index (TyGi) levels are linked to a higher risk of kidney problems in individuals with metabolic dysfunction-associated fatty liver disease (MAFLD). This study highlights TyGi as a potential predictor for adverse kidney outcomes in this patient group.
Area of Science:
- Metabolic health
- Nephrology
- Hepatology
Background:
- Metabolic dysfunction-associated fatty liver disease (MAFLD) is a growing health concern.
- The triglyceride-glucose index (TyGi) is a recognized marker for metabolic dysfunction.
- The relationship between TyGi trajectories and kidney outcomes in MAFLD patients remains under-explored.
Purpose of the Study:
- To investigate the association between longitudinal changes in TyGi and the risk of adverse kidney outcomes.
- To evaluate TyGi as a potential prognostic marker in patients diagnosed with MAFLD.
Main Methods:
- Latent class mixture modeling was used to define TyGi trajectories (decreasing vs. increasing) in 868 MAFLD patients.
- Kidney outcomes included sustained eGFR decline, dialysis initiation, or kidney transplantation.
- Cause-specific Cox proportional hazard models were employed to assess the risk.
Main Results:
- Over a median follow-up of 6.9 years, the increasing TyGi trajectory group showed a significantly higher incidence of kidney outcomes (9.06 per 1,000 person-years) compared to the decreasing group (4.02 per 1,000 person-years).
- The increasing TyGi trajectory was independently associated with a 3.68-fold greater risk of adverse kidney outcomes (HR, 3.68; 95% CI, 1.68-8.05).
- Subgroup analyses confirmed these consistent findings across different patient strata.
Conclusions:
- Elevated longitudinal TyGi levels are significantly associated with an increased risk of adverse kidney outcomes in patients with MAFLD.
- TyGi trajectories may serve as a valuable tool for risk stratification and prediction of kidney disease progression in MAFLD patients.
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