The U-shape relationship between insulin resistance-related indexes and chronic kidney disease: a retrospective cohort study from National Health and Nutrition Examination Survey 2007-2016

Abstract

Background: There is ongoing debate on the correlation between chronic kidney disease (CKD) and insulin resistance (IR)-related indices. Our objective was to explore the prognostic ability of IR-related indexes for the prevalence of CKD, as well as the mortality from all causes and cardiovascular disease (CVD) in CKD patients.

Methods: The data used in this study came from the National Health and Nutrition Examination Survey (NHANES). Binary logistic regression analysis, Cox proportional hazards model, and restricted cubic spline (RCS) were used to analyze the relationship between IR-related indexes, including metabolic score of IR (METS-IR), homeostatic model assessment for IR (HOMA-IR), triglyceride glucose index (TyG), triglyceride glucose-waist-to-height ratio (TyG-WHtR), triglyceride glucose-body mass index (TyG-BMI), with CKD and its all-cause mortality and CVD mortality. Subgroup analysis was performed to test the stability of the results. Finally, the predictive power of IR-related indexes for CKD was tested by the receiver operating characteristic (ROC) curve.

Results: Among the recruited 10,660 participants, 15.42% were CKD patients. All IR-related indexes were found to be nonlinearly correlated to the prevalence of CKD in the study. When the TyG index was higher than 9.05, it was positively associated with CKD (OR: 1.77, 95% CI 1.44-2.18). Moreover, increased TyG-WHtR level was correlated with a greater prevalence of CKD when it was higher than 4.3 (OR: 1.31, 95% CI 1.19-1.45). Other IR-related indexes (METS-IR, HOMA-IR, and TyG-BMI) showed fewer notable correlations with CKD. The association of IR-related indexes and the prevalence of CKD remained consistent in most subgroups (P for interactions > 0.05). TyG-WHtR was also the predictor of all-cause mortality in CKD patients (HR: 1.34, 95% CI 1.14-1.58), while other IR-related indexes were not correlated with the all-cause mortality or CVD mortality in CKD patients (P > 0.05). Otherwise, ROC curves showed that TyG-WHtR had more robust diagnostic efficacy than other IR-related indexes (METS-IR, HOMA-IR, TyG, and TyG-BMI) in predicting CKD (area under the curve: 0.630, 95% CI 0.615-0.644).

Conclusions: IR-related biomarkers (METS-IR, HOMA-IR, TyG, and TyG-BMI) were positively correlated with the prevalence of CKD. Moreover, TyG-WHtR enhanced CKD and its all-cause mortality prediction. In patients with elevated levels of IR-related indexes, the early detection and intervention of IR may reduce the occurrence of CKD and the prognosis of CKD patients.

Keywords: Chronic kidney disease; Insulin resistance; National Health and Nutrition Examination Survey; Triglyceride glucose index; Triglyceride glucose-waist-to-height ratio.

Fig. 1

Flowchart of the sample selection from NHANES 2007–2016. NHANES National Health and Nutrition Examination Survey, IR insulin resistance, eGFR estimated glomerular filtration rate, UACR urinary albumin-to-creatinine ratio

Fig. 2

Associations between A metabolic score of insulin resistance (METS-IR), B homeostatic model assessment for insulin resistance (HOMA-IR), C triglyceride glucose index (TyG), D triglyceride glucose-waist-to-height ratio (TyG-WHtR), and E triglyceride glucose-body mass index (TyG-BMI) with the risk of chronic kidney disease were evaluated by restricted cubic spline after adjustment for the covariables in model 3. The solid blue lines correspond to the central estimates, and the light blue regions indicate the 95% confidence intervals. The dashed lines parallel to the X-axis indicate that odd ratio = 1, and the dashed lines parallel to the Y-axis indicate that the X value is equal to the turning point

Fig. 3

Forest plot of A metabolic score of insulin resistance (METS-IR), B homeostatic model assessment for insulin resistance (HOMA-IR), C triglyceride glucose index (TyG), D triglyceride glucose-waist-to-height ratio (TyG-WHtR), and E triglyceride glucose-body mass index (TyG-BMI) association with the risk of chronic kidney disease

Fig. 4

Diagnostic efficacy of metabolic score of insulin resistance (METS-IR), homeostatic model assessment for insulin resistance (HOMA-IR), triglyceride glucose index (TyG), triglyceride glucose-waist-to-height ratio (TyG-WHtR), and triglyceride glucose-body mass index (TyG-BMI) for chronic kidney disease

Fig. 5

A Associations between triglyceride glucose-waist-to-height ratio (TyG-WHtR) and all-cause mortality in chronic kidney disease (CKD) patients. B The Kaplan–Meier curve for all-cause mortality of CKD patients based on different TyG-WHtR