Association between the triglyceride-glucose index and major adverse cardiovascular events in patients with chronic kidney disease stages 3–4

Abstract The association between the triglyceride–glucose (TyG) index and the risk of major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD) stages 3–4 has not been extensively studied. This study aims to investigate the relationship between baseline TyG index and MACE risk in a CKD stage 3–4 population. This study utilized data from the 2000–2022 China Renal Data System. Multivariate regression analysis models were constructed to explore the association between baseline TyG index and MACE. We employed restricted cubic splines to examine potential nonlinear correlations between these variables. Subgroup analyses were performed for different clinical endpoints. A total of 48,935 participants with CKD stages 3–4 were enrolled, with a mean TyG index of 8.88 8.45, 9.38. Participants were divided into quartiles based on TyG index values (quartile thresholds: 8.33, 8.78, 9.24). The overall prevalence of MACE was 15.90%. Multivariate Cox regression indicated a significant association between TyG quartiles and MACE occurrence, with hazard ratios (HR) of 1.08 (95% CI: 1.01–1.15, p = 0.016) for Quartile 1 and 1.12 (95% CI: 1.05–1.20, p = 0.001) for Quartile 4. Restricted cubic spline analysis revealed a nonlinear relationship between TyG index and MACE risk (P for nonlinearity < 0.001) among individuals with CKD stages 3–4. In patients with CKD stages 3–4, the TyG index shows a nonlinear association with the risk of MACE and all-cause mortality. These findings suggest that both elevated and reduced TyG index levels may increase the likelihood of MACE and all-cause mortality.