Kidney Week

Abstract: SA-PO0519

A Composite Triglyceride-Glucose-Body Roundness Index (TyG-BRI) Predicts CKD and All-Cause Mortality Beyond Conventional Risk Factors: NHANES, 1999-2018

Session Information

• CKD: Clinical - Therapies, CKM Health, Special Populations, and More
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Kodali, Naga Anvesh, University of Central Florida/HCA Florida Ocala Hospital, Ocala, Florida, United States

Naga Anvesh Kodali, MD, MBBS

• Gottipati, Bhavika, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, United States

Bhavika Gottipati, MD

• Seth, Sukriti, University of Central Florida/HCA Florida Ocala Hospital, Ocala, Florida, United States

Sukriti Seth, MBBS

• Desai, Hardik, AB Plus Multispecialty Hospital, Ahmedabad, Gujarat, India

Hardik Desai, MBBS

• Ventrapragada, Saila V., University of Central Florida/HCA Florida Ocala Hospital, Ocala, Florida, United States

Saila V. Ventrapragada, MD

Background

Insulin resistance and adiposity are central to chronic kidney disease (CKD) pathogenesis, yet conventional risk markers—fasting glucose, BMI, lipid fractions—fail to capture their synergistic nephrotoxic interaction. The Triglyceride–Glucose index (TyG) is a validated surrogate of insulin resistance, while the Body Roundness Index (BRI) provides a geometry-based estimate of visceral and total adiposity superior to BMI.

Methods

We analyzed data from 28,347 adults aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) 1999–2018 with complete anthropometric, biochemical, and mortality follow-up data. TyG index was calculated as ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. BRI was calculated using waist circumference and height. The composite TyG-BRI was derived as the product of standardized TyG and BRI values. CKD was defined as eGFR <60 mL/min/1.73m2 (CKD-EPI equation) and/or urine albumin-to-creatinine ratio ≥30 mg/g. All-cause mortality was ascertained through linkage to the National Death Index through December 2019. Multivariable logistic regression assessed TyG-BRI and CKD association. Weighted Cox proportional hazards models with restricted cubic splines evaluated TyG-BRI and mortality dose-response.

Results

The prevalence of CKD in the highest TyG-BRI quartile (Q4) was 31.4% compared to 14.2% in Q1. After full multivariable adjustment, Q4 vs. Q1 TyG-BRI conferred an OR of 2.74 (95% CI: 2.31–3.25; p<0.001) for prevalent CKD. TyG-BRI outperformed TyG alone (AUC: 0.73 vs. 0.68; ΔAUC: +0.05; p<0.001) and BRI alone (AUC: 0.73 vs. 0.70; p=0.003) in CKD discrimination. The NRI for TyG-BRI over the base model was 18.4% (95% CI: 12.1–24.7) and IDI was 3.2% (95% CI: 2.1–4.3). Over a median follow-up of 9.6 years (209,814 person-years), 3,841 deaths occurred. Restricted cubic spline analysis revealed a non-linear dose-response between TyG-BRI and all-cause mortality (p for non-linearity <0.001), with hazard rising sharply above the 70th percentile. Q4 TyG-BRI was associated with an adjusted HR of 1.68 (95% CI: 1.44–1.96) for all-cause mortality.

Conclusion

The TyG-BRI composite index independently predicts both prevalent CKD and long-term all-cause mortality in a nationally representative US population, outperforming its component indices and conventional risk factors.