Serum lipids and the progression of nephropathy in type 1 diabetes.

TLDR: Lid variables are associated with progression of diabetic kidney disease, but the relationship is not the same at all stages, which has implications for the design of renoprotective strategies and the interpretation of clinical trials in type 1 diabetes.

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 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 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 P 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.