Abstract
<title>Abstract</title> <p>Background Anthropometric (waist to height ratio [WHtR]) derivatives of the triglyceride-glucose index (TyG) and cholesterol, high-density lipoprotein, and glucose index (CHG), and the triglyceride-high-density lipoprotein-glucose-body index (TyHGB) have been proposed as indices of composite metabolic risk, and potential predictors for chronic kidney disease (CKD). This study evaluated the performance of these indices across distinct metabolic phenotypes. Methods The current analysis uses data from 17814 participants of the 2021 Iran STEPS survey. Participants were classified into four metabolic phenotypes according to overall metabolic risk, focusing on glucose and blood pressure regulation. Associations were examined using logistic regression. Dose-response relationships were assessed using restricted cubic spline (RCS) analysis. Discrimination was quantified via covariate-adjusted areas under the receiver operating characteristic curve (AUC). Results Evaluated indices showed strong associations with CKD in the general population and among high-risk metabolic phenotypes (all p-values < 0.001). All indices showed non-linear dose-response relationships with CKD in the general population (all p < 0.001). The indices showed modest discriminatory ability in the general population (AUCs 0.609–0.663) and among high-risk individuals (AUCs 0.560–0.592), but not those with low-risk phenotypes. Among evaluated indices, only TyG-WHtR and CHG-WHtR were associated with higher odds of CKD and provided additional discriminative power for individuals with intermediate metabolic risk. Conclusions The utility of composite risk indices appears to depend on baseline metabolic phenotype. The indices showed within-group discriminative value among individuals with established metabolic dysfunction, but not among metabolically healthier participants. Future studies should focus on longitudinal risk stratification in individuals with early-stage metabolic dysfunction.</p>