Dysglycemia but not lipids is associated with abnormal urinary albumin excretion in diabetic kidney disease: a report from the Kidney Early Evaluation Program (KEEP)

Abstract

BackgroundThe relationship between glycemic control and lipid abnormalities with urinary albumin-creatinine ratio (ACR) in chronic kidney disease (CKD) patients with diabetes mellitus (DM) is unknown. We sought to investigate the association of dyslipidemia and glycemic control with levels of albuminuria in the National Kidney Foundation (NKF) Kidney Early Evaluation Program (KEEP) participants with DM and CKD stage 3 or higher.MethodsWe performed a cross-sectional study of 6639 eligible KEEP patients with DM and CKD Stage 3 to 5 from June 2008 to December 2009. Multivariate logistic regression was used to evaluate the association of lipid parameters (per 10 mg/dl change in serum level) and glycosylated hemoglobin (HbA1c) values with three degrees of albuminuria normo (<30 mg⁄g), micro (30 to 300 mg⁄g) and macro (>300 mg⁄g).Results2141 KEEP participants were included. HbA1c levels were strongly associated with micro-albuminuria (compared to normo-albuminuria) and macro-albuminuria (compared to normo-albuminuria and micro-albuminuria). Each 1.0% increase in HbA1c increased the odds of micro-albuminuria by 32% (OR 1.32, 95% CI 1.23-1.42) and the odds of macro-albuminuria (vs. microalbuminuria) by 16% (OR 1.16, 95% CI 1.05-1.28). Only increases in serum HDL were associated with decreased odds of micro-albuminuria; otherwise, the association between other components of the serum lipid profile with urinary ACR did not reach statistical significance.ConclusionIn this cross-sectional study of 2141 KEEP participants with DM and CKD stages 3–5, overall glycemic control but not lipids were associated with abnormal urinary albumin excretion, a marker of increased risk for progressive disease.

Dyslipidemia, Kidney Disease, and Cardiovascular Disease in Diabetic Patients

“…In the Kidney Early Evaluation Program (KEEP) study of diabetic patients with CKD stage 3 to 5, only an elevated HDL-C level was associated with decreased odds of microalbuminuria [73]. There was no statistical significance between the albumin excretion rate and other lipid profiles in patients with T2D [73].…”

“…However, only levels of triglycerides progressively increased with albuminuria, from normoalbuminuria to microalbuminuria and to macroalbuminuria [72]. In the Kidney Early Evaluation Program (KEEP) study of diabetic patients with CKD stage 3 to 5, only an elevated HDL-C level was associated with decreased odds of microalbuminuria [73]. There was no statistical significance between the albumin excretion rate and other lipid profiles in patients with T2D [73].…”

Association of Albumin to Creatinine Ratio with Cardiovascular Risk Markers and Determination of Their Cut off Points in Type 2 Diabetic Nephropathy Patients

“…Study by Bose et al [9] found association of microalbuminuria and macroalbuminuria with HbA1c levels, and no association was found for other measured lipids. Increase in HDL cholesterol was noted with decreased incidence of microalbuminuria, while no significant association of lipid markers was found with urinary ACR.…”

“…The mechanism of this may be linked to the increased levels of atherogenic lipoproteins promoted by endothelial dysfunction. [8,9] Albuminuria (>300mg/24 hours) or microalbuminuria (≥30 mg/24 hours to 300mg/24 hours), or albumin/creatinine ratio (≥30 mg/g), is used as a marker of renal damage and is used to define chronic kidney disease along with low estimated glomerular filtration rate (eGFR). [10] Both cardiovascular disease and diabetes mellitus share many risk factors in common (the "common soil" hypothesis), [11] also lipid metabolism has been extensively investigated in diabetes; little information is available whether urine ACR is associated with lipids and lipoproteins.…”

Kidney Disease in Obesity and Metabolic Syndrome

“…In Kidney Early Evaluation Program (KEEP) participants with diabetes mellitus and CKD, increases in HDL levels were associated with decreased odds of moderately increased urine albumin excretion. However, overall glycemic control compared to dyslipidemia was a more significant predictor of increased albuminuria, a marker of CKD progression (Bose et al 2012). …”