GIANCARLO VIBERTI, MD, FRCP
4PER-HENRIK GROOP, MD, DMSC 2 OBJECTIVE -Dyslipidemia contributes to the progression of microvascular disease in diabetes. However, different lipid variables may be important at different stages of nephropathy. This study examines the pattern of dyslipidemia associated with the progression of nephropathy in patients with type 1 diabetes.RESEARCH DESIGN AND METHODS -A total of 152 patients with type 1 diabetes were recruited in order to represent various phases of nephropathy. Patients were followed for 8 -9 years, during which time they received standard care. Renal progression was defined a priori as a doubling in albumin excretion (in patients with normo-or microalbuminuria) or a decline in creatinine clearance (in those with macroalbuminuria). A panel of lipid variables was determined and correlated with indexes of progression.RESULTS -In patients with normoalbuminuria (n ϭ 66), progression was associated with male sex (P Ͻ 0.05), borderline albuminuria (P ϭ 0.02), and LDL-free cholesterol (P ϭ 0.02). In patients with microalbuminuria (n ϭ 51), progression was independently associated with triglyceride content of VLDL and intermediate-density lipoprotein (both P Ͻ 0.05). In patients with macroalbuminuria (n ϭ 36), a significant decline in the renal function (Ͼ3 ml ⅐ min Ϫ1 ⅐ year Ϫ1 ) was independently associated with poor glycemic control, hypertension, and LDL size (P Ͻ 0.05). When all patients with progressive nephropathy were analyzed together, only LDL cholesterol was predictive on multivariate analysis (P Ͻ 0.05), which masked the importance of triglyceride enrichment in microalbuminuria.CONCLUSIONS -Lipid variables are associated with progression of diabetic kidney disease, but the relationship is not the same at all stages. This finding has implications for the design of renoprotective strategies and the interpretation of clinical trials in type 1 diabetes.
Diabetes Care 29:317-322, 2006T he control of blood lipids is one of the cornerstones in the treatment of type 1 diabetes. Apart from effects on macrovascular outcomes (1), dyslipidemia potentially contributes to microvascular disease (2,3). Prospective studies have confirmed a link between serum lipids and nephropathy (4 -10), although lipid fractions measured in these studies have been limited, and parameters associated with kidney disease have not been consistently identified (8,9). It remains to be established which lipids or lipoproteins are most important in the pathogenesis of nephropathy and should therefore be targeted for intervention. Furthermore, it may be that different lipid variables are important at different stages of diabetic kidney disease. For example, triglycerides and cholesterol appeared to have different effects on the progression of nephropathy, depending upon the duration of diabetes (10). Consequently, this study makes a detailed examination of the pattern of dyslipidemia associated with the progression of nephropathy, at each stage of renal disease, in patients with type 1 diabetes followed fo...
