Serum Lipids and the Progression of Nephropathy in Type 1 Diabetes

  1. Merlin C. Thomas, MBCHB, PHD, FRACP1,
  2. Milla Rosengård-Bärlund, MD2,
  3. Vashti Mills, BSC2,
  4. Mats Rönnback, MD2,
  5. Stephen Thomas, PHD, MRCP2,
  6. Carol Forsblom, MD, DMSC2,
  7. Mark E. Cooper, MBBS, PHD1,
  8. Marja-Riitta Taskinen, MD, DMSC3,
  9. Giancarlo Viberti, MD, FRCP4 and
  10. Per-Henrik Groop, MD, DMSC2
  1. 1The Baker Heart Research Institute, Melbourne, Australia
  2. 2Division of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
  3. 3Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
  4. 4Cardiovascular Division, Guy’s Hospital, King’s College, London, U.K.
  1. Address correspondence and reprint requests to Per-Henrik Groop, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, PoB 63, FIN-00014, Finland. E-mail: per-henrik.groop{at}helsinki.fi

Abstract

OBJECTIVE—Dyslipidemia contributes to the progression of microvascular disease in diabetes. However, different lipid variables may be important at different stages of nephropathy. This study examines the pattern of dyslipidemia associated with the progression of nephropathy in patients with type 1 diabetes.

RESEARCH DESIGN AND METHODS—A total of 152 patients with type 1 diabetes were recruited in order to represent various phases of nephropathy. Patients were followed for 8–9 years, during which time they received standard care. Renal progression was defined a priori as a doubling in albumin excretion (in patients with normo- or microalbuminuria) or a decline in creatinine clearance (in those with macroalbuminuria). A panel of lipid variables was determined and correlated with indexes of progression.

RESULTS—In patients with normoalbuminuria (n = 66), progression was associated with male sex (P < 0.05), borderline albuminuria (P = 0.02), and LDL-free cholesterol (P = 0.02). In patients with microalbuminuria (n = 51), progression was independently associated with triglyceride content of VLDL and intermediate-density lipoprotein (both P < 0.05). In patients with macroalbuminuria (n = 36), a significant decline in the renal function (>3 ml · min−1 · year−1) was independently associated with poor glycemic control, hypertension, and LDL size (P < 0.05). When all patients with progressive nephropathy were analyzed together, only LDL cholesterol was predictive on multivariate analysis (P < 0.05), which masked the importance of triglyceride enrichment in microalbuminuria.

CONCLUSIONS—Lipid variables are associated with progression of diabetic kidney disease, but the relationship is not the same at all stages. This finding has implications for the design of renoprotective strategies and the interpretation of clinical trials in type 1 diabetes.

Footnotes

  • Additional information for this article can be found in an online appendix at http://care.diabetesjournals.org.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted November 1, 2005.
    • Received May 4, 2005.
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This Article

  1. doi: 10.2337/diacare.29.02.06.dc05-0809 Diabetes Care February 2006 vol. 29 no. 2 317-322
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