Association of the triglyceride-glucose index with albuminuria: a systematic review and meta-analysis

Albuminuria is an early marker of glomerular microvascular injury and can predict the progression of chronic kidney disease (CKD). The triglyceride-glucose (TyG) index, a convenient surrogate indicator of insulin resistance, has been associated with renal injury, but its relationship with albuminuria remains unclear. This study aims to systematically evaluate the relationship between the TyG index and the risk of albuminuria.

We searched PubMed, Embase, Web of Science, and the Cochrane Library for relevant studies published up to January 1, 2026. Observational studies reporting the association between the TyG index and albuminuria, and providing effect estimates with 95% confidence intervals (CIs) were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) and the Agency for Healthcare Research and Quality (AHRQ) tool. Heterogeneity was assessed using the I ² statistic, and subgroup analyses, sensitivity analyses, and publication bias assessments were conducted.

A total of 14 studies (13 cross-sectional studies and 1 cohort study) were included, with a combined sample size of 59,148 participants. The cross-sectional pooled analysis showed that a higher TyG index was significantly associated with albuminuria (OR = 2.37, 95% CI: 1.26-4.43; I ² = 85.5%). After excluding one outlier study reporting an extreme effect size, the association remained statistically significant (OR = 1.61, 95% CI: 1.48-1.75), with heterogeneity decreasing to 53.5%. Subgroup analyses by population type, region, adjustment for renal function indicators, sample size, and BMI adjustment revealed consistent positive correlations without significant intergroup differences. Leave-one-out analyses demonstrated robust results. The results of the publication bias risk assessment were primarily driven by an outlier study. After excluding that study, no significant small-study effects were observed. The sole cohort study suggested an increased risk of new-onset albuminuria with higher TyG index (HR = 1.19, 95% CI 1.03-1.37).

Available evidence indicates that elevated TyG index correlates with increased risk of albuminuria across different populations. Limited longitudinal evidence also supports an association between TyG and heightened risk of new-onset albuminuria. The TyG index may serve as a simple metabolic marker for early renal risk stratification, though further large-scale prospective studies are needed to clarify temporal relationships and potential causality.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420261290210, identifier CRD420261290210.