Association between triglyceride-glucose index and treatment response in primary membranous nephropathy: a retrospective cohort study

The triglyceride-glucose (TyG) index, a marker of insulin resistance, has been linked to chronic kidney disease and proteinuria severity, but its prognostic value for treatment response in primary membranous nephropathy (PMN) is unclear. We evaluated whether baseline TyG predicts 12-month proteinuria remission in PMN. We included 363 patients with PMN. The primary outcome was 12-month remission per 2021 KDIGO criteria. Missing covariates were handled by multiple imputation (20 datasets). Multivariable logistic regression adjusted for anti-PLA2R antibody (continuous, per 100 RU/mL), albumin, 24-hour urine protein, age, sex, comorbidities, and treatment group. Sensitivity analyses included TyG tertiles, restriction to standard immunotherapy, complete remission, binary anti-PLA2R status, eGFR adjustment, log-transformed and restricted cubic spline modeling of anti-PLA2R antibody, complete-case analysis, inverse probability of treatment weighting, post-hoc power analysis, and adjustment for treatment switching. Among 363 patients, 267 (73.6%) achieved remission. Baseline TyG was not independently associated with remission (OR = 0.839, 95% CI: 0.544–1.293, p = 0.425). Higher anti-PLA2R antibody levels were associated with lower odds of remission when modeled continuously (OR per 100 RU/mL = 0.836, 95% CI: 0.704–0.992, p = 0.041), but not when dichotomized (OR = 0.666, 95% CI: 0.213–2.089, p = 0.484). Addition of TyG minimally improved model discrimination (AUC 0.714 to 0.716). Results were consistent across sensitivity analyses. Baseline TyG was not independently associated with 12-month remission in PMN and provided minimal incremental predictive value. However, a moderate association cannot be excluded given the confidence interval. Anti-PLA2R antibody level showed an inverse association when modeled continuously.