Diabetic dyslipidaemia linked to nephropathy risk
medwireNews: The presence of diabetic dyslipidaemia may explain why patients with Type 2 diabetes develop kidney disease despite good risk factor control, say researchers.
Giuseppina Russo (University of Messina, Italy) and colleagues found that low levels of high-density lipoprotein (HDL) cholesterol and high levels of triglycerides were linked to kidney disease risk even after accounting for blood pressure and glycaemic control.
“These results may have important therapeutic implications”, they say, noting the reduced risk of albuminuria among patients who received fibrate treatment in the ACCORD trial.
Almost a third of the 15,362 Type 2 diabetes patients in the current study developed kidney complications during 4 years of follow-up, although the researchers note this high rate may be partly due to selection bias, with the patients being identified via specialist clinics. In all, 23.3% developed albuminuria, 12.8% developed a low estimated glomerular filtration rate and 4.0% developed both.
The rate of either outcome was significantly higher among patients with elevated triglycerides (≥150 mg/dL) at baseline, at 34.6% compared with 31.0% among those without. And the same was true for low HDL cholesterol levels (<40 mg/dL for men; <50 mg/dL for women), at 34.8% versus 30.9%.
The team found no evidence of a threshold effect when analysing the lipid markers as continuous variables. For example, each 50 mg/dL increase in triglycerides raised the risk of albuminuria by a significant 6% and each 10 mg/dL increase in HDL cholesterol lowered it by 7%.
The size of the effect was reduced after accounting for factors including age, body mass index, diabetes duration, blood pressure, lipid-lowering medications and glycated haemoglobin levels, reflecting “the major role played by classical risk factors”.
However, the association remained statistically significant, indicating that “an independent role of lipid fractions on kidney function is still plausible, as supported by several pieces of experimental evidence”, write the researchers in Diabetes Care.
They add that their data indicate that HDL cholesterol may contribute more strongly than triglycerides to kidney outcomes in diabetes patients, although they stress that both lipid fractions were independently prognostic and that the risk associated with the two “cannot be directly compared”.
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