Plasma Triglycerides and HDL-C Levels Predict the Development of Diabetic Kidney Disease in Subjects With Type 2 Diabetes: The AMD Annals Initiative

• Published in: Diabetes care Vol. 39; no. 12; pp. 2278 - 2287
• Main Authors: Russo, Giuseppina T., De Cosmo, Salvatore, Viazzi, Francesca, Pacilli, Antonio, Ceriello, Antonio, Genovese, Stefano, Guida, Pietro, Giorda, Carlo, Cucinotta, Domenico, Pontremoli, Roberto, Fioretto, Paola
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01.12.2016
• Subjects: Aged; Albuminuria - blood; Albuminuria - diagnosis; Albuminuria - epidemiology; Blood Glucose - metabolism; Blood Pressure; Cholesterol, HDL - blood; Cholesterol, LDL - blood; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - epidemiology; Diabetic Nephropathies - blood; Diabetic Nephropathies - diagnosis; Diabetic Nephropathies - epidemiology; Diabetic Nephropathies - physiopathology; Dyslipidemias - blood; Dyslipidemias - complications; Dyslipidemias - diagnosis; Dyslipidemias - epidemiology; Female; Glucose; Humans; Incidence; Italy - epidemiology; Low density lipoprotein; Male; Middle Aged; Prognosis; Retrospective Studies; Risk Factors; Triglycerides - blood
• DOI: 10.2337/dc16-1246
• ISSN: 0149-5992; 1935-5548

Despite the achievement of blood glucose, blood pressure, and LDL cholesterol (LDL-C) targets, the risk for diabetic kidney disease (DKD) remains high among patients with type 2 diabetes. This observational retrospective study investigated whether diabetic dyslipidemia-that is, high triglyceride (TG) and/or low HDL cholesterol (HDL-C) levels-contributes to this high residual risk for DKD. Among a total of 47,177 patients attending Italian diabetes centers, 15,362 patients with a baseline estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m , normoalbuminuria, and LDL-C ≤130 mg/dL completing a 4-year follow-up were analyzed. The primary outcome was the incidence of DKD, defined as either low eGFR (<60 mL/min/1.73 m ) or an eGFR reduction >30% and/or albuminuria. Overall, 12.8% developed low eGFR, 7.6% an eGFR reduction >30%, 23.2% albuminuria, and 4% albuminuria and either eGFR <60 mL/min/1.73 m or an eGFR reduction >30%. TG ≥150 mg/dL increased the risk of low eGFR by 26%, of an eGFR reduction >30% by 29%, of albuminuria by 19%, and of developing one abnormality by 35%. HDL-C <40 mg/dL in men and <50 mg/dL in women were associated with a 27% higher risk of low eGFR and a 28% risk of an eGFR reduction >30%, with a 24% higher risk of developing albuminuria and a 44% risk of developing one abnormality. These associations remained significant when TG and HDL-C concentrations were examined as continuous variables and were only attenuated by multivariate adjustment for numerous confounders. In a large population of outpatients with diabetes, low HDL-C and high TG levels were independent risk factors for the development of DKD over 4 years.