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

• Published in: Diabetologia 2009-12, Vol.52 (12), p.2522-2530
• Main Authors: Tolonen, N, Forsblom, C, Thorn, L, Wadén, J, Rosengård-Bärlund, M, Saraheimo, M, Feodoroff, M, Mäkinen, V.-P, Gordin, D, Taskinen, M.-R, Groop, P.-H
• Format: Article
• Language: English
• Subjects: Adult; Age of Onset; Apolipoprotein A-II - blood; Apolipoproteins; Apolipoproteins B - blood; Associated diseases and complications; Biological and medical sciences; Blood Pressure; Cardiovascular disease; Cholesterol; Cohort Studies; Diabetes; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - complications; Diabetes. Impaired glucose tolerance; Diabetic nephropathy; Diabetic Neuropathies - blood; Diabetic Neuropathies - epidemiology; Diabetic Neuropathies - physiopathology; Disease Progression; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Finland - epidemiology; Follow-Up Studies; High density lipoprotein; Human Physiology; Humans; Internal Medicine; Kidney diseases; Kidneys; Lipids; Lipids - physiology; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Nephrology. Urinary tract diseases; Predictive Value of Tests; Prospective Studies; Time Factors; Triglycerides - blood; Urinary system involvement in other diseases. Miscellaneous; Urine
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-009-1541-2

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 HDL₃-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, HbA₁c, male sex and AER were all independent predictors of renal disease. High total cholesterol, LDL-cholesterol, non-HDL-cholesterol and triacylglycerol as well as low HDL-cholesterol, HDL₂-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.