41 Poor Glycemic Control but not Dyslipidemia is Associated with Albuminuria in Patients with Chronic Kidney Disease (CKD) and Type 2 Diabetes Mellitus (T2DM): A Kidney Early Evaluation Program (KEEP) Report

Abstract

POOR GLYCEMIC CONTROL BUT NOT DYSLIPIDEMIA IS ASSOCIATED WITH ALBUMINURIA IN PATIENTS WITH CHRONIC KIDNEY DISEASE (CKD) AND TYPE 2 DIABETES MELLITUS (T2DM): A KIDNEY EARLY EVALUATION PROGRAM (KEEP) REPORT Subhasish Bose, Nehal N. Mehta, Shu-Cheng Chen, Suying Li, Peter A. McCullough. University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota; St. John Providence Health System, Providence Park Heart Institute, Novi, Michigan. Dyslipidemia and albuminuria have both been associated with unfavorable cardiovascular prognosis in patients with T2DM. However, the direct relation between lipid abnormalities and overall glycemic control with urinary albumin-creatinine ratio (ACR) in CKD patients with T2DM has not been elucidated. We sought to investigate the association of dyslipidemia and glycemic control with albuminuria in KEEP participants with T2DM and CKD stage ≤3. Our study included a total of 6639 eligible KEEP patients from June ‘08 to December ‘09 with glycosylated hemoglobin (HbA1c) values. After excluding nondiabetic, non-CKD and patients with missing values of urinary ACR, the total sample size was 2141. Baseline characteristics and health screening results based on quartiles of HbA1c were compared. We performed multivariate logistic regressions in estimating individual association of lipid parameters (per 10 mg/dl change in serum level) and HbA1c values with ACR, adjusting for age, gender and race. These associations were compared across different degrees of ACR groups: normo-albuminuria ( 300 mg/g). Association between components of serum lipid profile with ACR was not significant. HbA1c was associated with ACR when compared between normo-albuminuria and micro-albuminuria groups [OR=1.32, (95% CI: 1.23-1.41), p<0.001]. Association was attenuated in the micro-albuminuria versus macroalbuminuria groups [OR=1.15, (95% CI: 1.05-1.27), p<0.01]. In this cross-sectional study of 2141 KEEP participants with T2DM and CKD, overall glycemic control measured by HbA1C but not dyslipidemia was associated with urinary ACR.