Dyslipoproteinemia and Impairment of Renal Function in Diabetic Kidney Disease: An Analysis of Animal Studies, Observational Studies, and Clinical Trials

Abstract

■ AbstractDyslipoproteinemia is highly prevalent in diabetes, chronic kidney disease, and diabetic kidney disease (DKD). Both diabetes and chronic kidney disease (CKD) are associated with hypertriglyceridemia, lower high-density lipoprotein, and higher small, dense low-density lipoprotein. A number of observational studies have reported that dyslipidemia may be associated with albuminuria, renal function impairment, and end-stage renal disease (ESRD) in the general population, and especially in CKD and DKD patients. Diabetic glomerulopathy and the related albuminuria are the main manifestations of DKD. Numerous animal studies support the finding that glomerular atherosclerosis is the main mechanism of glomerulosclerosis in CKD and DKD. Some randomized, controlled trials suggest the use of statins for the prevention of albuminuria and renal function impairment in CKD and DKD patients. However, a large clinical study, the Study of Heart and Renal Protection (SHARP), does not support that statins could reduce ESRD in CKD. In this article, we analyze the complex association of dyslipoproteinemia with DKD and deduce its relevance from animal studies, observational studies, and clinical trials. We show that special subgroups could benefit from the statin treatment.

Association of Postbreakfast Triglyceride and Visit-to-Visit Annual Variation of Fasting Plasma Glucose with Progression of Diabetic Nephropathy in Patients with Type 2 Diabetes

“…In addition to high BP and hyperglycemia, dyslipidemia, characterized by high fasting triglycerides (TG) and low HDL cholesterol, has an important role in the progression of kidney disease in patients with diabetes [5]. Although a number of observational studies have reported that dyslipidemia may be associated with albuminuria, renal function impairment, and end-stage renal disease in the general population, studies are scarce investigating a relationship between dyslipidemia and albuminuria in diabetes [6]. Cross-sectional studies have found an association between fasting serum triglycerides (FTG) and the development of micro- and macroalbuminuria [7, 8].…”

Glomerular diseases outcome at one year in a tertiary care centre.

“…Protective role of statins is well documented in subgroups of patients with chronic kidney disease. 7 , 15 Other factors like body mass index and ethnicity are also influencing course of diabetic nephropathy. 16 - 18 …”

Management of anemia in patients with diabetic kidney disease: A consensus statement

“…In clinical settings, other than diabetic glomerulopathy-related albuminuria is another key event and major manifestation of DKD that is important. [ 37 38 ] However, since evaluation of albuminuria and eGFR might have inherent limitations, a combination of them is expected to provide better clinical picture for identifying the progression of DKD in a particular individual. This clinical impression differentiating those with progressive CKD (defined as a decline in GFR of >5 ml/min/1.73 m 2 within 1 year or >10 ml/min/1.73 m 2 within 5 years) from stable ones has potential implications on management that may be tailored according to the patients age and stage of the DKD.…”