Triglycerides and Renal Outcomes According to Albuminuria and in Consideration of Other Metabolic Syndrome Components in Diabetic US Veterans - PubMed (original) (raw)
Triglycerides and Renal Outcomes According to Albuminuria and in Consideration of Other Metabolic Syndrome Components in Diabetic US Veterans
John G Rizk et al. Am J Nephrol. 2023.
Abstract
Introduction: Hypertriglyceridemia, a component of the metabolic syndrome, is a known independent predictor of albuminuria and chronic kidney disease (CKD) in the general population. Previous studies have shown that the relationship of triglycerides (TGs) with outcomes changes across stages of CKD. Our objective was to examine the association of TG independent of other metabolic syndrome components with renal outcomes in diabetic patients with or without CKD.
Methods: This retrospective cohort study included diabetic US veteran patients with valid data on TGs, estimated glomerular filtration rate (eGFR), and albuminuria (urinary albumin/creatinine ratio) between fiscal years 2004 and 2006. Using Cox models adjusted for clinical characteristics and laboratory markers, we evaluated the relationship of TG with incident albuminuria (stratified by eGFR category) and based on eGFR (stratified by baseline albuminuria categories). To evaluate the relationship of TG with time to end-stage renal disease (ESRD), we stratified models by baseline CKD stage (eGFR category) and baseline albuminuria stage ascertained at time of TG measurement.
Results: In a cohort of 138,675 diabetic veterans, the mean ± SD age was 65 ± 11 years old and included 3% females and 14% African Americans. The cohort also included 28% of patients with non-dialysis-dependent CKD (eGFR <60 mL/min/1.73 m2), as well as 28% of patients with albuminuria (≥30 mg/g). The median (IQR) of serum TG was 148 (100, 222) mg/dL. We observed a slight positive linear association between TG and incident CKD after adjustment for Case-Mix and Laboratory variables among non-albuminuric and microalbuminuric patients. The relationship of high TG trended towards a higher risk of ESRD in CKD 3A non-albuminuric patients and in CKD 3A and 4/5 patients with microalbuminuria.
Conclusion: In a large cohort, we have shown that elevated TGs are associated with all kidney outcomes tested independently of other metabolic syndrome components in diabetic patients with normal eGFR and normal albumin excretion rate, but the association is weaker in some groups of diabetic patients with preexisting renal complications.
Keywords: Albuminuria; Chronic kidney disease; Metabolic syndrome; Renal outcomes; Triglycerides.
© 2023 The Author(s). Published by S. Karger AG, Basel.
Conflict of interest statement
Conflicts of Interest/Disclosures:
KKZ has received honoraria and/or support from Abbott, Abbvie, Alexion, Amgen, American Society of Nephrology, Astra-Zeneca, AVEO Oncology, Chugai, DaVita, Fresenius, Genentech, Haymarket Media, Hofstra Medical School, International Federation of Kidney Foundations, International Society of Hemodialysis, International Society of Renal Nutrition & Metabolism, Japanese Society of Dialysis Therapy, Hospira, Kabi, Keryx, Novartis, National Institutes of Health, National Kidney Foundation, OPKO, Pfizer, Relypsa, Resverlogix, Sandoz, Sanofi, Shire, Vifor, UpToDate, and ZSPharma. CPK has received honoraria from Akebia, Ardelyx, Astra-Zeneca, Bayer, Cara Therapeutics, Reata and Tricida. Other authors do not have a conflict of interest.
Figures
Figure 1.
Association of Serum Triglycerides and Time to ESRD in Case-Mix+Lab Adjustment Across Stages of CKD and Albuminuria: A) Al, B) A2 and C) A3. Case-Mix+Lab: age, gender, race, ethnicity, ever smoking, ever alcoholic, Charlson Comorbidity Index, myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, chronic pulmonary disease, dementia, liver disease, cancer, atrial fibrillation, hypertension, depression and ischemic heart disease, prescription of statins, non-statins and RAASi and albumin, eGFR, logged UACR, BMI, HgbAlc and HDL.
Figure 2.
Association of Serum Triglycerides and Time to Incident CKD in Case-Mix+Lab Adjustment Among Non-CKD Patients and Across Albuminuria Stages. Case-Mix+Lab: age, gender, race, ethnicity, ever smoking, ever alcoholic, Charlson Comorbidity Index, myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, chronic pulmonary disease, dementia, liver disease, cancer, atrial fibrillation, hypertension, depression and ischemic heart disease, prescription of statins, non-statins and RAASi and albumin, eGFR, logged UACR, BMI, HgbAlc and HDL.
Figure 3.
Association of Serum Triglycerides and Time to Incident Albuminuria of A) ≥30 mg/g and B) >300 mg/g in Case-Mix+Lab Adjustment Among Albuminuria Al Patients. Case-Mix+Lab: age, gender, race, ethnicity, ever smoking, ever alcoholic, Charlson Comorbidity Index, myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, chronic pulmonary disease, dementia, liver disease, cancer, atrial fibrillation, hypertension, depression and ischemic heart disease, prescription of statins, non-statins and RAASi and albumin, eGFR, logged UACR, BMI, HgbAlc and HDL.
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