A new study published in theNature Scientific Reportsrevealed that elevated triglyceride-glucose (TyG) index levels were strong predictors of all-cause and cardiovascular (CV) mortality in patients starting peritoneal dialysis (PD). Further research is needed to compare TyG with other insulin sensitivity markers and validate findings across diverse populations The study was conducted among 553 PD patients who began therapy between 2003 and 2017, to explore whether TyG index levels could forecast mortality risk. Insulin resistance (IR) is known to contribute to elevated fasting glucose and triglyceride levels, both of which are common in patients with end-stage renal disease. While direct measurement of IR is costly and complex, the TyG index offers an accessible alternative. The participants were divided into 3 groups (tertiles) based on their TyG index values at the start of the study. This research monitored the cohort for over a decade, analyzing mortality outcomes using Cox proportional hazard models while adjusting for a wide range of potential confounders including age, gender, medication use, comorbidities, and laboratory parameters related to PD. During the follow-up period, 142 deaths occurred, of which 89 were attributed to cardiovascular causes. In multivariable-adjusted models, patients in the highest TyG tertile (tertile 3) had more than twice the risk of death compared with those in the lowest tertile (tertile 1). Specifically, the hazard ratio (HR) for all-cause mortality was 2.12 (95% confidence interval [CI] 1.31–3.43, p = 0.021), and for cardiovascular mortality, the HR was 2.78 (95% CI 1.34–5.76, p = 0.006). When the TyG index was analyzed as a continuous variable the association remained significant. Each standard deviation increase in TyG index was linked to a proportionally higher risk of both all-cause and cardiovascular deaths, which highlighted the robustness of the relationship. Receiver operating characteristic (ROC) analysis further determined the optimal TyG cut-off values for mortality prediction. For all-cause mortality, the ideal cut-off was 8.79, showing a sensitivity of 62.7% and specificity of 61.6%, with an area under the curve (AUC) of 0.652. For cardiovascular mortality, the cut-off was slightly higher at 8.85, with 66.3% sensitivity, 62.9% specificity, and an AUC of 0.681. Overall, these results suggest that elevated TyG index values could serve as an early warning signal for clinicians managing PD patients. Hsu, K.-M., Hsieh, Y.-P., Chang, Y.-J., Tsai, S.-M., & Chiu, P.-F. (2025). Triglyceride-glucose index predicts the mortality risk among incident peritoneal dialysis patients in a cohort study. Scientific Reports, 15(1), 35283.https://doi.org/10.1038/s41598-025-19171-8