Triglyceride-glucose index is significantly associated with the risk of hyperuricemia in patients with diabetic kidney disease

Abstract

Triglyceride-glucose (TyG) index has been proposed to be a simple, economical, and reliable marker of insulin resistance. We aimed to investigate whether TyG is an independent predictor of hyperuricemia in diabetic kidney disease (DKD) populations by conducting a cross-sectional and longitudinal study. A total of 6,471 patients were enrolled in cross-sectional analysis, and 3,634 patients without hyperuricemia at the baseline were included in longitudinal analysis and were followed up for a median of 23.0 months. Hyperuricemia was categorized as a serum uric acid level ≥ 420 umol/L (7 mg/dL). In this study, 19.58% of participants had hyperuricemia. In the cross-sectional analysis, multivariate logistics regression analysis showed that the ORs (95% CI) for hyperuricemia in the second, third, and fourth TyG quartiles were 1.40 (95% CI 0.73-2.65), 1.69 (95% CI 0.90-3.18), and 4.53 (95% CI 2.39-8.57), respectively, compared with the first quartile. Longitudinally, the Kaplan-Meier survival analysis showed that higher TyG levels predicted higher incidence of hyperuricemia. Multivariate Cox regression model revealed that the hazard ratios for hyperuricemia in the upper quartiles of the TyG index were 1.69 (95% CI 0.97-2.93), 2.23 (95% CI 1.33-3.75), and 2.50 (95% CI 1.46-4.27), respectively, compared with the first quartile. Moreover, the subgroup analyses revealed that the relationship between TyG levels and hyperuricemia was robust in DKD patients. Our findings indicate a significant independent correlation between the TyG index and the risk of hyperuricemia in DKD patients.

Figure 1

Relationship between baseline TyG and the hyperuricemia (a) the prevalence of hyperuricemia in the cross-sectional analysis, by baseline TyG quartile: < 9.02; quartile 2, 9.02–9.45 quartile 3, 9.45–9.96; quartile 4, ≥ 9.96; (b) the incidence of hyperuricemia ( per 1,000 person-years) in the cohort analysis, by baseline TyG quartile: quartile 1, < 9.00; quartile 2, 9.00–9.42; quartile 3, 9.42–9.90; quartile 4, ≥ 9.90;

Figure 2

Kaplan–Meier curves for hyperuricemia by TyG quartile: quartile 1 (< 25), < 9.00; quartile 2 (25 ~), 9.00–9.42; quartile 3 (50 ~), 9.42–9.90; and quartile 4 (≥ 75), ≥ 9.90. P value < 0.05 for log-rank test, other quartiles versus first quartile.

Figure 3

Stratified analyses of the association between the TyG index and the incidence of hyperuricemia. Adjusted for age, sex,HDL-C, LDL-C, BMI, eGFR, 24hTP, SBP, DBP and HbA1c.

Figure 4

Flow chart of subject selection for this study.