Serum Lipids and the Progression of Nephropathy in Type 1 Diabetes

Thomas, Merlin C; Rosengård-Bärlund, Milla; Mills, Vashti; Rönnback, Mats; Thomas, Stephen; Forsblom, Carol; Cooper, Mark E.; Taskinen, Marja‐Riitta; Viberti, Giancarlo; Groop, Per Henrik

doi:10.2337/diacare.29.02.06.dc05-0809

Cited by 70 publications

(56 citation statements)

References 25 publications

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“…Dyslipidemia, as the strongest single factor for elevated LDL cholesterol, is associated with progression of diabetic kidney disease (12,26). We found that both LDL cholesterol and triglycerides are independently associated with microalbuminuria.…”

Section: Figure 3-influence Of A1c On Development Of Microalbuminuriamentioning

confidence: 64%

Diabetic Nephropathy in 27,805 Children, Adolescents, and Adults With Type 1 Diabetes

et al. 2007

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OBJECTIVE -To give an up-to-date profile of nephropathy and the involvement of risk factors in a large, prospective cohort of patients with type 1 diabetes and largely pediatric and adolescent onset of disease. RESEARCH DESIGN AND METHODS-A total of 27,805 patients from the nationwide, prospective German Diabetes Documentation System survey were included in the present analysis. Inclusion criteria were at least two documented urine analyses with identical classification. Urine analyses, treatment regimens, diabetes complications, and risk factors were recorded prospectively. Baseline characteristics were age at diagnosis 9.94 years (median [interquartile range 5.8 -14.3]), age at last visit 16.34 years (12.5-22.2), and follow-up time 2.5 years (0.43-5.3). Cumulative incidence of nephropathy was tested by Kaplan-Meier analysis and association with risk factors by logistic regression.RESULTS -Nephropathy was classified as normal in 26,605, microalbuminuric in 919, macroalbuminuric in 78, and end-stage renal disease (ESRD) in 203 patients. After calculated diabetes duration of 40 years, 25.4% (95% CI 22.3-28.3) had microalbuminuria and 9.4% (8.3-11.4) had macroalbuminuria or ESRD. Risk factors for microalbuminuria were diabetes duration (odds ratio 1.033, P Ͻ 0.0001), A1C (1.13, P Ͻ 0.0001), LDL cholesterol (1.003, P Ͻ 0.0074), and blood pressure (1.008, P Ͻ 0.0074), while childhood diabetes onset (1.011, P Ͻ 0.0001) was protective. Male sex was associated with the development of macroalbuminuria.CONCLUSIONS -Diabetes duration, A1C, dyslipidemia, blood pressure, and male sex were identified as risk factors for nephropathy. Therefore, besides the best possible metabolic control, early diagnosis and prompt treatment of dyslipidemia and hypertension is mandatory in patients with type 1 diabetes. Diabetes Care 30:2523-2528, 2007M icro-and macroalbuminuria are important markers for early and progressive diabetic kidney disease. Patients with type 1 diabetes face a 20 -50% probability of developing endstage renal disease (ESRD) requiring dialysis or renal transplantation (1). But over the last decades, cumulative incidence of nephropathy has further declined, which was attributed to intensified treatment regimens and a more aggressive therapy of hypertension and dyslipidemia (1,2).Since the 1980s, microalbuminuria has been established as an early marker of progressive kidney disease in diabetes (3), starting at pediatric age (4,5), and currently albumin excretion rate (AER) remains the best available noninvasive predictor for diabetic nephropathy and should be measured regularly according to established guidelines (6 -8).Since the Diabetes Control and Complications Trial (DCCT), glycemic control was established as the dominant risk factor for the development of diabetic nephropathy (9). Moreover, the DCCT follow-up Epidemiology of Diabetes Interventions and Complications study has demonstrated a persistent delay of progression of diabetic nephropathy 7-8 years after the end of the DCCT, in the previously intensively trea...

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Section: Figure 3-influence Of A1c On Development Of Microalbuminuriamentioning

confidence: 64%

Diabetic Nephropathy in 27,805 Children, Adolescents, and Adults With Type 1 Diabetes

et al. 2007

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“…However, more recent larger cohort studies have not been able to replicate all these findings after adjusting for confounding variables [8]. Dyslipidaemia not only promotes cardiovascular risk, but may also play a role in the progression of diabetic nephropathy [9]. However, it is not yet clear whether the lipid abnormalities precede or coincide with the increase in AER.…”

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confidence: 80%

Relationship between lipid profiles and kidney function in patients with type 1 diabetes

et al. 2007

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Aims/hypothesis We studied the relationship between the lipid profile, estimated GFR (eGFR) and AER in patients with type 1 diabetes. We also assessed the association between the lipid profile and glycaemic control, obesity and hypertension in an environment free of manifest renal disease, as well as exploring how well the patients would have achieved the targets set in international guidelines. Methods A total of 2,927 adult patients who had type 1 diabetes and for whom lipid profiles were available were included from people participating in the nationwide, multicentre Finnish Diabetic Nephropathy Study (FinnDiane). eGFR was determined using the Cockcroft-Gault formula adjusted for body surface area. Results Patients with impaired renal function (eGFR <60 ml min −1 1.73 m −2 ) had higher total cholesterol, triacylglycerol and apolipoprotein B, and lower HDLcholesterol concentrations than patients with normal renal function (eGFR >90 ml min −1 1.73 m −2 ) or mildly impaired renal function (eGFR 60-90 ml min −1

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“…Earlier small studies have suggested that lipid variables might be involved in the development and progression of diabetic nephropathy [10,11], but it can also be argued that the lipid abnormalities are merely a consequence of albuminuria. Recently, a large prospective clinical trial showed an improvement of renal function in patients treated with atorvastatin [12].…”

Section: Introductionmentioning

confidence: 99%

“…It is obvious that these studies did not have enough power to analyse a potential link between the lipid profile and the development of renal disease [10,11,15]. In contrast, the EURODIAB study included a large number of patients with type 1 diabetes from different parts of Europe and also a much larger number of patients who progressed with respect to their renal disease.…”

Section: Introductionmentioning

confidence: 99%

Lipid abnormalities predict progression of renal disease in patients with type 1 diabetes

et al. 2009

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Aims/hypothesis We studied the impact of baseline lipid variables on the progression of renal disease in a large nationwide prospective cohort of patients with type 1 diabetes. Methods A total of 2,304 adult patients with type 1 diabetes and available lipid profiles participating in the Finnish Diabetic Nephropathy Study (FinnDiane) were evaluated. Data on progression of renal disease were verified from medical files and patients were followed for 5.4±2.0 (mean ± SD) years. Results High triacylglycerol, apolipoprotein (Apo) B, ApoA-II and HDL 3 -cholesterol concentrations predicted incident microalbuminuria. Progression to macroalbuminuria was predicted by high triacylglycerol and ApoB. When AER was entered into the model, triacylglycerol was no longer an independent predictor, but when patients with normal AER and microalbuminuria at baseline were pooled, triacylglycerol, HbA 1c , male sex and AER were all independent predictors of renal disease. High total cholesterol, LDLcholesterol, non-HDL-cholesterol and triacylglycerol as well as low HDL-cholesterol, HDL 2 -cholesterol, ApoA-I and ApoA-II concentrations were predictive of progression to end-stage renal disease. However, when estimated GFR was entered into the model, only total cholesterol remained an independent predictor of progression. Conclusions/interpretation Lipid abnormalities, particularly high triacylglycerol concentrations, increase the risk of progression of renal disease.

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Serum Lipids and the Progression of Nephropathy in Type 1 Diabetes

Cited by 70 publications

References 25 publications

Diabetic Nephropathy in 27,805 Children, Adolescents, and Adults With Type 1 Diabetes

Diabetic Nephropathy in 27,805 Children, Adolescents, and Adults With Type 1 Diabetes

Relationship between lipid profiles and kidney function in patients with type 1 diabetes

Lipid abnormalities predict progression of renal disease in patients with type 1 diabetes

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