Higher HDL cholesterol levels are associated with a lower incidence of chronic kidney disease in patients with type 2 diabetes

Zoppini, G.; Targher, G.; Chonchol, M.; Perrone, F.; Lippi, G.; Muggeo, M.

doi:10.1016/j.numecd.2008.11.003

« Previous Next »Nutrition, Metabolism & Cardiovascular Diseases
Volume 19, Issue 8 , Pages 580-586, October 2009

Higher HDL cholesterol levels are associated with a lower incidence of chronic kidney disease in patients with type 2 diabetes

G. Zoppini
- Section of Endocrinology, Department of Biomedical and Surgical Sciences, University of Verona, Ospedale Civile Maggiore, Piazzale Stefani, 1, 37126 Verona, Italy
- These authors contributed equally to this work.
G. Targher
- Section of Endocrinology, Department of Biomedical and Surgical Sciences, University of Verona, Ospedale Civile Maggiore, Piazzale Stefani, 1, 37126 Verona, Italy
- Corresponding author. Tel.: +39 045 8123748; fax: +39 045 8027314.
- These authors contributed equally to this work.
M. Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Health Sciences Center, Denver, USA
F. Perrone
- Section of Endocrinology, Department of Biomedical and Surgical Sciences, University of Verona, Ospedale Civile Maggiore, Piazzale Stefani, 1, 37126 Verona, Italy
G. Lippi
- Section of Clinical Chemistry, Department of Biomedical and Morphological Sciences, University of Verona, Verona, Italy
M. Muggeo
- Section of Endocrinology, Department of Biomedical and Surgical Sciences, University of Verona, Ospedale Civile Maggiore, Piazzale Stefani, 1, 37126 Verona, Italy

Received 22 August 2008; received in revised form 17 October 2008; accepted 10 November 2008. published online 04 February 2009.

Abstract

Background and aims

Type 2 diabetes is one of the most important risk factor for the development of chronic kidney disease (CKD). Recently, it has been shown that lower high-density lipoprotein cholesterol (HDL-C) levels predicted the development of microalbuminuria in type 2 diabetic individuals. We have prospectively assessed the effects of plasma HDL-C levels on the incidence of CKD in a large cohort of type 2 diabetic patients.

Methods and results

We followed 1987 type 2 diabetic outpatients with normal or near-normal kidney function at baseline for 5 years for the occurrence of incident CKD defined as glomerular filtration rate≤60mL/min/1.73m² (as estimated by the abbreviated Modified Diet and Renal Disease Study equation). Cox proportional hazards models were used to examine the independent relationship between plasma HDL-C levels and incident CKD. During a median follow-up of 5 years, 11.8% (n=234) of participants developed incident CKD. In multivariate regression analysis, higher HDL-C levels were associated with a lower risk of incident CKD (multiple-adjusted hazard ratio 0.76; 95% coefficient intervals 0.61–0.96; p=0.025) independently of age, gender, body mass index, hypertension, smoking history, diabetes duration, hemoglobin A1c, plasma triglycerides, LDL-cholesterol, presence of diabetic retinopathy, baseline albuminuria, and current use of medications (anti-hypertensive, anti-platelet, lipid-lowering and hypoglycemic drugs).

Conclusions

Higher plasma levels of HDL-C are associated with a lower risk of incident CKD in a large cohort of type 2 diabetic adults independently of numerous confounding factors.

Keywords: HDL-C, Chronic kidney disease, Type 2 diabetes, Risk factors