Abstract
Background: Studies investigating serum triglycerides (TG) and renal outcomes including ESRD were mixed, and often these studies were unable to account for potential confounding for MetS components. It remains unclear how these relationships may present in patients with diabetic kidney disease and in consideration of albuminuria, or UACR. Methods: We studied 138,675 US diabetic veterans, with data on serum TG and UACR from 2004-2006 and follow-up until 2014. Using Cox models adjusted for clinical characteristics and laboratory markers (including UACR, body mass index, hemoglobin A1c and high-density lipoprotein), we evaluated the relationship of baseline TG with time to ESRD. All models were stratified by baseline CKD stage and baseline albuminuria stage ascertained at time of TG measurement. Results: The cohort was 65±11 years old, and included 28% with CKD 3A-5, and 4% with UACR >300 mg/g. The median[IQR] of TG was 146[99,217] mg/dL. In non-albuminuric patients, we observed a linear relationship between TG and transition to ESRD among non-CKD patients, yet a U-shaped relationship for CKD 3A-3B (ref: TG 120-<160 mg/dL). The relationship with TG ≥ 240 mg/dL diminished across CKD stages, where it was attenuated for CKD 4/5 patients (p-trend =0.05). In microalbuminuria patients, a trend towards an elevated risk of ESRD transition for TG ≥ 240 mg/dL was observed in CKD 3A and 4/5 only. Finally, patients with macroalbuminuria and elevated TG did not have a clear pattern in risk of ESRD across CKD stages (p-trend= 0.73). [Figure] Conclusion: In patients with diabetes and CKD, high TG levels predicted ESRD in CKD 3A non-albuminuria patients and in CKD 3A and 4/5 in patients with microalbuminuria. These associations were independent of glycemic control, MetS components, and medications including lipid-lowering drugs. These findings highlight the importance of investigating the impact of lipid modulating therapies specifically among patients with diabetic kidney disease.
Published Version
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