Hypertriglycéridémie et néphropathie chez le diabétique de type 1: acteur ou marqueur ?

Abstract

Aims/hypothesis

We studied the impact of baseline lipid variables on the progression of renal disease in a large nationwide prospective cohort of persons with type 1 diabetes.

Methods

A total of 2,304 adults with type 1 diabetes and available lipid profiles participating in the Finnish Diabetic Nephropathy Study (FinnDiane) were evaluated. Data on progression of renal disease were verified from medical files, and patients were followed for 5.4 ± 2.0 years (mean ± SD).

Results

High triacylglycerol, apolipoprotein (Apo) B, ApoA-II and HDL3-cholesterol concentrations predicted incident microalbuminuria. Progression to macroalbuminuria was predicted by high triacylglycerol and ApoB. When AER was entered into the model, triacylglycerol was no longer an independent predictor, but when persons with normal AER and microalbuminuria at baseline were pooled, triacylglycerol, HbA1c, male sex and AER were all independent predictors of renal disease. High total cholesterol, LDLcholesterol, non-HDL-cholesterol and triacylglycerol as well as low HDL cholesterol, HDL2-cholesterol, ApoA-I and ApoA-II concentrations were predictive of progression to end-stage renal disease. However, when estimated GFR was entered into the model, only total cholesterol remained an independent predictor of progression.

Conclusions/interpretation

Lipid abnormalities, particularly high triacylglycerol concentrations, increase the risk of progression of renal disease.