Association Between the Triglycerides-to-High-Density Lipoprotein-Cholesterol (TG/HDL-C) Ratio and Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Observational Studies.

Abstract

<h4>Background</h4>The relationship between the triglycerides-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio and the risk of developing chronic kidney disease (CKD) remains unclear, as CKD is a major health challenge worldwide. This study aimed to investigate the association between the TG/HDL-C ratio and the risk of developing CKD.<h4>Methods</h4>To find studies that examined the association of TG/HDL-C ratio (without stratification restrictions for TG/HDL-C) with CKD or renal disorders, PubMed, Embase, Scopus, Google Scholar, and Web of Science databases, as well as study references, were searched by two independent investigators with no time limit until July 31, 2025 by related MeSH Terms. Heterogeneity among studies was assessed using the Cochran's Q and I² tests. Meta-regression was employed to manage the heterogeneity.<h4>Results</h4>Eleven studies involving 376,697 participants were included. The pooled prevalence of CKD was 12% (95% CI: 7-16). Subgroup analysis showed a significant positive correlation between increasing TG/HDL-C ratio and increasing CKD prevalence. The prevalence of CKD in quartiles 1, 2, 3, and 4 was 8%, 10%, 12% and 15%, respectively. A high TG/HDL-C ratio (q4) versus a low one (q1) was significantly associated with increased risk of CKD (OR: 1.26, 95% CI: 1.13, 1.39, I²: 73.8%, p: 0.001). Subgroup analysis showed that the increased risk of CKD in men and women with high versus low TG/HDL-C ratio was 27% and 23%, respectively (p < 0.05).<h4>Conclusion</h4>A high versus low TG/HDL-C ratio was significantly associated with an increased risk of CKD. This association was stronger in men than in women. Despite its limitations, the TG/HDL-C ratio can be used as a simple, reliable and accessible biomarker for assessing CKD risk.