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Objective: Hypertriglyceridemia, a component of the metabolic syndrome, is a known independent predictor of albuminuria and chronic kidney disease (CKD) in the general population. Previous studies have shown that the relationship of triglycerides with outcomes changes across stages of CKD. Our objective is to examine the association of triglycerides independent of other metabolic syndrome components with renal outcomes in diabetic patients with or without CKD. Research Design and Methods: This retrospective cohort study included diabetic US veteran patients with valid data on triglycerides (TG), estimated glomerular filtration rate (eGFR) and albuminuria (UACR), between fiscal years 2004 to 2006. Using Cox models adjusted for clinical characteristics and laboratory markers, we evaluated the relationship of TG with incident albuminuria (stratified by eGFR category) and based on eGFR (stratified by baseline albuminuria categories). To evaluate the relationship of TG with time to end-stage renal disease (ESRD), we stratified models by baseline CKD stage (eGFR category) and baseline albuminuria stage ascertained at time of TG measurement. Results: In a cohort of 138,675 diabetic veterans, the mean±SD age was 65±11 years old, and included 3% females and 14% African Americans. The cohort also included 28% of patients with non-dialysis dependent CKD (eGFR<60 mL/min/173m2), as well as 28% of patients with albuminuria (≥30 mg/g). The median[IQR] of serum TG was 148[100, 222] mg/dL. We observed a slight positive linear association between TG and incident CKD after adjustment for case-mix and laboratory variables among non-albuminuric and microalbuminuric patients. High TG levels were associated with ESRD in CKD 3A non-albuminuric patients and in CKD 3A and 4/5 in patients with microalbuminuria. Conclusions: In a large cohort, we have shown that elevated TG are associated with all kidney outcomes tested independently of other metabolic syndrome components in diabetic patients with normal eGFR and normal albumin excretion rate, but the association is weaker in some groups of diabetic patients with pre-existing renal complications.

Background Hyperkalemia is associated with kidney function decline in patients with non-dialysis dependent chronic kidney disease, but this relationship is unclear for residual kidney function among hemodialysis (HD) patients. Methods We conducted a retrospective cohort study of 6655 patients who started HD from January 2007 to December 2011 and who had data on renal urea clearance (KRU). Serum potassium levels were stratified into four groups (i.e. ≤4.0, &gt;4.0 to ≤ 4.5, &gt;4.5 to ≤ 5.0, &gt;5.0 mEq/L) and 1-year KRU slope for each group was estimated by a linear mixed-effects model. Results Higher serum potassium was associated with greater decline in KRU, and the greatest decrease in KRU (-0.20, 95% CI -0.50, -0.06) was observed for baseline potassium &gt; 5.0 mEq/L in the fully adjusted model. Mediation analysis showed that KRU slope mediated 1.78% of the association between serum potassium and mortality. Conclusions In conclusion, hyperkalemia is associated with decline in residual kidney function amongst incident HD patients. These findings may have important clinical implications in the management of hyperkalemia in advanced CKD if confirmed in additional studies including clinical trials.