Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA.
Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, California, USA.
Am J Nephrol. 2023;54(1-2):14-24. doi: 10.1159/000529414. Epub 2023 Mar 8.
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.
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.
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.
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.
高甘油三酯血症是代谢综合征的一个组成部分，是一般人群中白蛋白尿和慢性肾脏病（CKD）的一个已知独立预测因子。先前的研究表明，甘油三酯（TGs）与结局的关系在 CKD 各阶段发生变化。我们的目的是检查 TG 与糖尿病患者肾脏结局的关系，这些患者无论是否患有 CKD，均不受其他代谢综合征成分的影响。
本回顾性队列研究纳入了在 2004 年至 2006 年期间有 TG、估算肾小球滤过率（eGFR）和白蛋白尿（尿白蛋白/肌酐比）有效数据的美国退伍军人糖尿病患者。使用调整临床特征和实验室标志物的 Cox 模型，我们评估了 TG 与事件性白蛋白尿（按 eGFR 类别分层）以及基于 eGFR（按基线白蛋白尿类别分层）的关系。为了评估 TG 与终末期肾脏疾病（ESRD）的时间关系，我们按基线 CKD 阶段（eGFR 类别）和在 TG 测量时确定的基线白蛋白尿阶段对模型进行分层。
在 138675 名糖尿病退伍军人队列中，平均年龄±标准差为 65±11 岁，包括 3%的女性和 14%的非裔美国人。该队列还包括 28%的非透析依赖 CKD（eGFR<60 mL/min/1.73 m2）患者和 28%的白蛋白尿患者（≥30 mg/g）。血清 TG 的中位数（IQR）为 148（100，222）mg/dL。在调整病例组合和实验室变量后，我们观察到在非白蛋白尿和微量白蛋白尿患者中，TG 与 CKD 事件之间存在轻微的正线性关联。在 CKD 3A 非白蛋白尿患者和 CKD 3A 和 4/5 微量白蛋白尿患者中，高 TG 与 ESRD 的风险呈上升趋势。
在一个大型队列中，我们表明，在 eGFR 和正常白蛋白排泄率正常的糖尿病患者中，升高的 TGs 与所有测试的肾脏结局独立相关，不受其他代谢综合征成分的影响，但在一些存在肾脏并发症的糖尿病患者群体中，这种关联较弱。
