Non-insulin-based insulin resistance indices for predicting all-cause mortality and renal outcomes in patients with stage 1-4 chronic kidney disease: another paradox

Feng-Ching Shen; Hugo You-Hsien Lin; Wei-Chung Tsai; I-Ching Kuo; Yi-Kong Chen; Yu-Lin Chao; Sheng-Wen Niu; Chi-Chih Hung; Jer-Ming Chang

doi:10.3389/fnut.2023.1136284

Non-insulin-based insulin resistance indices for predicting all-cause mortality and renal outcomes in patients with stage 1-4 chronic kidney disease: another paradox

Front Nutr. 2023 May 15:10:1136284. doi: 10.3389/fnut.2023.1136284. eCollection 2023.

Authors

Feng-Ching Shen^{1

2}, Hugo You-Hsien Lin^{1

3

4}, Wei-Chung Tsai^{4

5

6}, I-Ching Kuo^{1

3

4}, Yi-Kong Chen^{1

2}, Yu-Lin Chao^{1

2}, Sheng-Wen Niu^{1

3

4}, Chi-Chih Hung^{1

4}, Jer-Ming Chang^{1

4}

Affiliations

¹ Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
² Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
³ Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
⁴ Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵ Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁶ Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Abstract

Non-insulin-based insulin resistance (IR) indices serve as the indicators of metabolic syndrome (MetS) but have limited value for predicting clinical outcomes. Whether the obesity paradox affects the predictive value of these indicators in patients with chronic kidney disease (CKD) remains unknown. We investigated whether MetS and non-insulin-based IR indices can predict all-cause mortality and renal outcomes in a prospective observational study with stage 1-4 CKD Asians (N = 2,457). These IR indices were associated with MetS. A Cox regression model including body mass index (BMI) revealed an association between MetS and renal outcomes. Among the IR indices, only high triglyceride-glucose (TyG) index was associated with adverse renal outcomes: the hazard ratio of Q4 quartile of the TyG index was 1.38 (1.12-1.70). All-cause mortality was marginally associated with MetS but not high IR indices. Low TyG and TyG-BMI indices as well as low BMI and triglyceride were paradoxically associated with increased risks of clinical outcomes. The triglyceride-to-high-density lipoprotein cholesterol ratio and metabolic score for IR indices were not associated with clinical outcomes. In conclusion, MetS and TyG index predict renal outcome and obesity paradox affects the prediction of IR indices in patients with stage 1-4 CKD.

Keywords: TyG index; all-cause mortality; non-insulin-based insulin resistance indices; obesity paradox; renal outcome; stage 1–4 chronic kidney disease.