The aim of this study is to evaluate the role of the triglyceride-glucose (TyG) index as a predictive marker for insulin resistance in pre-diabetic patients with chronic kidney disease (CKD), and to investigate its potential utility as a simple, non-invasive alternative to traditional insulin resistance assessment methods.

Diabetes mellitus remains a major public health challenge worldwide due to its increasing prevalence and associated complications, particularly when undiagnosed in its early stages. Early identification of individuals at high risk is essential for timely intervention to delay or prevent disease onset. Traditional diagnostic tools may miss early metabolic disturbances, necessitating more sensitive and accessible biomarkers.

The triglyceride-glucose (TyG) index, derived from fasting plasma triglycerides and glucose, has recently emerged as a simple, reliable, and cost-effective surrogate marker for insulin resistance. Its utility has been validated in multiple populations, showing strong associations with metabolic dysfunction and future development of diabetes.

Renal dysfunction is frequently associated with alterations in glucose and lipid metabolism, even before overt diabetes develops. However, the diagnostic accuracy of traditional risk markers may be compromised in the context of impaired kidney function. The TyG index offers potential advantages due to its independence from insulin measurements and ease of calculation.

Despite growing evidence on the predictive role of the TyG index, limited data exist regarding its performance across different levels of kidney function. Investigating its diagnostic value in patients with and without renal impairment may provide a valuable tool for early diabetes risk assessment and targeted preventive strategies.

Inclusion Criteria:

• Adults aged ≥18 years

Patients with medical history free from renal dysfunction

Patients with renal dysfunction (CKD stages 2_5 based on KDIGO guidelines)

No previous diagnosis of diabetes mellitus

Provided informed consent

Exclusion Criteria:

• Known type 1 or type 2 diabetes mellitus

Acute kidney injury

Use of steroids or medications that affect glucose and lipid metabolism

Pregnancy

Active infections

Malignancy

Adults aged ≥18 years with medical history free from renal dysfunction or with renal dysfunction (CKD stages 2_5 based on KDIGO guidelines)