The Triglyceride-Glucose Index: An Accessible Tool for Risk Stratification in Chronic Kidney Disease

Background: Chronic kidney disease (CKD) presents a significant global burden, requiring accessible risk assessment tools. Insulin resistance (IR), pivotal in cardiometabolic pathologies, contributes significantly to kidney injury and progression. The triglyceride-glucose (TyG) index offers a simple, cost-effective, insulin-independent surrogate for IR. This review synthesizes evidence on TyG’s utility, limitations, and future directions concerning kidney disease outcomes. Methods: A literature search was conducted in PubMed, Scopus, and Google Scholar for publications from December 2008 to May 2025. Systematic reviews, meta-analyses, and observational studies (cohort, cross-sectional) were included, examining TyG’s relationship with kidney disease (incident CKD, progression, DKD), T2DM as a DKD risk factor, and cardiometabolic outcomes in CKD populations. Results: Evidence from diverse cohorts has consistently shows elevated TyG index consistently associated with increased risk of incident T2DM, incident CKD, established CKD progression (including ESRD), and prevalent/incident diabetic kidney disease (DKD). Higher TyG also independently predicted increased cardiovascular events and mortality in CKD. Mechanistically, TyG reflects IR-driven pathways (endothelial dysfunction, oxidative stress, inflammation) linked to kidney damage. Existing challenges include the lack of standardized formula/thresholds and complex associations in diverse CKD subgroups. Conclusion: The TyG index is a promising marker for increased risk of developing and progressing CKD, including DKD. Although evidence demonstrates its association with adverse renal/cardiorenal outcomes, this needs to be clarified and standardized through robust clinical validation in diverse CKD populations, while adjusting for potential confounders to promote its application in CKD risk assessment.