HDL Cholesterol, Triglycerides Associated With Diabetic Kidney Disease Risk

Patients with type 2 diabetes, high triglyceride levels, and low HDL cholesterol levels may have a higher risk of developing diabetic kidney disease, according to research published in Diabetes Care.

“Hyperglycemia and hypertension are the main risk factors for [diabetic kidney disease] development and progression. However, in spite of the achievement of recommended targets for blood glucose and blood pressure, the residual risk for diabetic nephropathy remains high among patients with type 2 diabetes,” the researchers wrote, also noting that “epidemiological studies have demonstrated a link between diabetic dyslipidemia and [diabetic kidney disease].”

To learn more, Giuseppina T. Russo, MD, PhD, of the University of Messina in Italy, and colleagues from the AMD-Annals Study Group evaluated patients with type 2 diabetes who attended Italian diabetes centers and had a baseline estimated glomerular filtration rate (eGFR) of at least 60 mL/min/1.73 m², normoalbuminuria, and LDL cholesterol levels of 130 mg/dL or lower.

Of all 15,362 patients with 4-year follow-up data available, 12.8% developed low eGFR (values lower than 60 mL/min/1.73 m²), while 7.6% experienced a greater than 30% reduction in eGFR and 23.2% developed albuminuria. Four percent also developed albuminuria along with low eGFR or reduced eGFR.

Results linked triglyceride levels greater than 150 mg/dL to a 26% increased risk for low eGFR and a 29% increased risk for reduced eGFR. High triglyceride levels were also associated with a 19% increased risk for albuminuria and a 35% increased risk for both low eGFR and albuminuria. 

Additionally, the researchers found a relationship between low HDL cholesterol, defined as less than 40 mg/dL in men and less than 50 mg/dL in women, and a 27% increased risk for low eGFR and a 28% increased risk for reduced eGFR. Risks for albuminuria and both albuminuria and low eGFR were also increased by 24% and 44%, respectively, with low HDL cholesterol concentrations.

Further, when examined as continuous variables, each 50-mg/dL increase in triglycerides augmented the risks for low eGFR by 10% and eGFR reduction by 8%, and increased the risks for albuminuria by 6% and at least 1 abnormality by 13%, respectively. Each 10-mg/dL increase in HDL cholesterol, however, was associated with a 9% decline in risk for low eGFR or albuminuria, a 9% decline in risk for reduced eGFR, and risk for developing 1 abnormality dropped by 12%.

The study results were only attenuated by multivariate adjustment.

Study limitations included the observational design, a lack of centralized measurements and standardization of laboratory parameters, and the absence of information on duration of use of hypoglycemic and hypolipidemic drugs.

“Our data clearly indicate that both high [triglycerides] and low HDL cholesterol are independent risk factors for [diabetic kidney disease] development,” the researchers wrote.

“Only large, long-term interventional studies will clarify whether lipid-lowering medications decreasing [triglyceride] levels and/or increasing HDL cholesterol levels are effective in reducing [diabetic kidney disease] risk among patients with type 2 diabetes,” they added.

Disclosures: The researchers report no conflicts of interest.

Reference

1. Russo GT, De Cosmo S, Viazzi F, et al; for the AMD-Annals Study Group. Plasma triglycerides and HDL-C levels predict the development of diabetic kidney disease in subjects with type 2 diabetes: the AMD Annals Initiative. Diabetes Care. 2016 Oct 4. doi:10.2337/dc16-1246 [Epub ahead of print].