Association Between Cumulative Changes of the C-Reactive Protein-Triglyceride Glucose Index and the Incidence of Rapid Kidney Function Decline: A Nationwide Prospective Cohort Study

Why It Matters

Identifying cuCTI as a dynamic risk marker enables earlier detection of CKD progression, offering clinicians a practical tool to intervene before irreversible kidney damage occurs.

Key Takeaways

• Each 1‑unit rise in cuCTI increases RKFD odds by 18%
• Persistently high CTI (class 4) yields nearly four‑fold RKFD risk
• Association holds across sex, education, hypertension and diabetes subgroups
• NHANES confirms higher CTI links to lower eGFR in US adults

Pulse Analysis

Chronic kidney disease (CKD) remains a leading cause of morbidity worldwide, yet its early stages are often missed because conventional biomarkers such as serum creatinine only rise after substantial loss of function. Researchers are therefore seeking dynamic indicators that capture subtle, pre‑clinical changes. Inflammation and insulin resistance are two biological pathways repeatedly implicated in renal injury, and the C‑reactive protein‑triglyceride glucose index (CTI) merges these signals into a single metric. By tracking CTI over time, the cumulative CTI (cuCTI) reflects both the intensity and duration of metabolic‑inflammatory stress, offering a more nuanced view than a single measurement.

The recent CHARLS analysis followed nearly 7,000 middle‑aged and older Chinese participants for four years, documenting that higher cuCTI predicts rapid kidney function decline (RKFD) independent of traditional risk factors. A one‑unit increase in cuCTI raised RKFD odds by 18%, while individuals with consistently elevated CTI faced almost a four‑fold increase. Dose‑response modeling showed a linear risk escalation, and subgroup tests revealed consistent effects across gender, education, hypertension, diabetes and other comorbidities. Sensitivity checks using imputed data and an external NHANES cohort reinforced the findings, demonstrating that the CTI‑eGFR relationship transcends geographic and ethnic boundaries.

These insights have practical implications for clinicians and health systems. Routine measurement of CRP, triglycerides and fasting glucose—already part of standard metabolic panels—can be combined to calculate CTI, enabling risk stratification without additional testing costs. Patients identified with rising or persistently high cuCTI could benefit from targeted interventions such as anti‑inflammatory therapies, tighter glycemic control, and lifestyle modifications aimed at reducing insulin resistance. Moreover, incorporating cuCTI into predictive algorithms may improve the accuracy of CKD screening programs, ultimately slowing disease progression and reducing the economic burden of end‑stage renal disease.