The triglyceride-glucose index in chronic kidney disease: a narrative review

Chronic kidney disease (CKD), defined by the progressive and irreversible deterioration of renal structure and function stemming from diverse etiological factors, poses a formidable and escalating public health burden on a global scale. Concurrently, insulin resistance (IR), a pathophysiological state characterized by diminished cellular responsiveness to insulin, presents a complex and multifactorial metabolic derangement. The triglyceride-glucose (TyG) index has emerged as a robust, accessible, and reliable surrogate marker for quantifying this IR status. A growing body of evidence underscores a profound and intricate interconnection between the IR state and the pathogenesis, initiation, and advancement of CKD. Delineating this relationship carries significant consequential value for the enhancement of early identification, refined risk stratification, and improved therapeutic management and preventive strategies for CKD. This article conducts a comprehensive narrative review and critical analysis of contemporary scientific investigations pertaining to the applicability and prognostic utility of the TyG index in forecasting, diagnosing, and evaluating the progression and clinical outcomes of CKD. Through a synthesis of pertinent literature, this review further elucidates the potential mechanistic pathways linking the TyG index to CKD pathogenesis, encompassing its influence on metabolic homeostasis, the exacerbation of insulin resistance, and the propagation of chronic inflammatory processes. The overarching objective is to contribute novel evidentiary support for predicting the trajectory of CKD, its associated complications, and long-term prognoses, thereby proposing innovative avenues for pioneering clinical diagnostics and preemptive interventional measures.