Abstract
Objective We examined whether or not day-to-day variations in lipid profiles, especially triglyceride (TG) variability, were associated with the exacerbation of diabetic kidney disease. Methods We conducted a retrospective and observational study. First, 527 patients with type 2 diabetes mellitus (DM) who had had their estimated glomerular filtration rate (eGFR) checked every 6 months since 2012 for over 5 years were registered. Variability in postprandial TG was determined using the standard deviation (SD), SD adjusted (Adj-SD) for the number of measurements, and maximum minus minimum difference (MMD) during the first three years of follow-up. The endpoint was a ≥40% decline from baseline in the eGFR, initiation of dialysis or death. Next, 181 patients who had no micro- or macroalbuminuria in February 2013 were selected from among the 527 patients for an analysis. The endpoint was the incidence of microalbuminuria, initiation of dialysis, or death. Results Among the 527 participants, 110 reached a ≥40% decline from baseline in the eGFR or death. The renal survival was lower in the higher-SD, higher-Adj-SD, and higher-MMD groups than in the lower-SD, lower-Adj-SD, and lower-MMD groups, respectively (log-rank test p = 0.0073, 0.0059, and 0.0195, respectively). A lower SD, lower Adj-SD, and lower MMD were significantly associated with the renal survival in the adjusted model (hazard ratio, 1.62, 1.66, 1.59; 95% confidence intervals, 1.05-2.53, 1.08-2.58, 1.04-2.47, respectively). Next, among 181 participants, 108 developed microalbuminuria or death. The nonincidence of microalbuminuria was lower in the higher-SD, higher-Adj-SD, and higher-MMD groups than in the lower-SD, lower-Adj-SD, and lower-MMD groups, respectively (log-rank test p = 0.0241, 0.0352, and 0.0474, respectively). Conclusions Postprandial TG variability is a novel risk factor for eGFR decline and the incidence of microalbuminuria in patients with type 2 DM.
Highlights
Diabetic mellitus (DM) is the most common cause of end-stage renal disease (ESRD) worldwide and is closely associated with increased cardiovascular risk and mortality [1] [2]
Recent epidemiological studies suggest that diabetic kidney disease (DKD) patients have a variety of clinical presentations and progression rates to ESRD typical clinical manifestations of DKD are characterized by slow progression from microalbuminuria to macroalbuminuria and by hyperfiltration at the early stage and a progressive decline in the glomerular filtration rate (GFR) at the advanced stage
TG: triglyceride; SD: standard deviation; Adj-SD: adjusted SD; MMD: maximum minus minimum difference; HR: hazard ratio; 95% CI: 95% confidence intervals; BMI: body mass index; eGFR: estimated glomerular filtration rate; HbA1c: glycated hemoglobin
Summary
Diabetic mellitus (DM) is the most common cause of end-stage renal disease (ESRD) worldwide and is closely associated with increased cardiovascular risk and mortality [1] [2]. The data from the United States Renal Data System showed that after a year-by-year rise in the number of incident ESRD cases from 1980 through 2000, the count plateaued between 2007 and 2011 but rose again from 2012 to 2017 due to the aging of the population and the increasing prevalence of obesity and DM [3]. Recent epidemiological studies suggest that diabetic kidney disease (DKD) patients have a variety of clinical presentations and progression rates to ESRD typical clinical manifestations of DKD are characterized by slow progression from microalbuminuria to macroalbuminuria and by hyperfiltration at the early stage and a progressive decline in the glomerular filtration rate (GFR) at the advanced stage. Some DKD patients lose their renal functions without albuminuria [4]. This population is presumably related to atherosclerosis by aging, hypertension, and dyslipidemia. Components of metabolic syndrome, like abdominal obesity, hypertension, hyperglycemia, and dyslipidemia, are highly interrelated and contribute to the development and progression of DKD [5]
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