NDT Advance Access published online on March 27, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn149
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Effects of albuminuria and renal dysfunction on development of dyslipidaemia in type 2 diabetes—the Hong Kong Diabetes Registry
1 Department of Medicine and Therapeutics 2 Hong Kong Institute of Diabetes and Obesity 3 Li Ka Shing Institute of Health Sciences 4 Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong, China
Correspondence and offprint requests to: Wing Yee So, 9/F Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China. Tel: +852-2632-3138; Fax: +852-2632-3108; E-mail: wingyeeso{at}cuhk.edu.hk
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Abstract |
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Background. It is uncertain whether albuminuria precedes the future development of high total cholesterol (TC > 6.2 mmol/l) and high LDL-C (>4.1 mmol/l) while renal dysfunction precedes the future development of low HDL-C (<0.9 mmol/l) in type 2 diabetes.
Methods. A prospective cohort of 2761 type 2 diabetic patients without significant dyslipidaemia and having at least one measurement of TC, LDL-C and HDL-C during 2.8 years of follow-up was analysed. The spline Cox regression model was used to derive hazard ratio (HR) curves of the spot urinary albumin:creatinine ratio (ACR) and the estimated glomerular filtration rate (eGFR) for dyslipidaemia, followed by standard Cox models to confirm the findings from the HR curves.
Results. Seven percent of the cohort developed high TC, 4.6% developed high LDL-C and 5.7% developed low HDL-C during follow-up. In multivariate analysis, the HR of ACR for high TC and high LDL-C increased rapidly and linearly from zero with no apparent threshold. Patients with macroalbuminuria (ACR 
25 mg/mmol) were, respectively, 1.6- and 2.4 folds more likely to develop high TC and high LDL-C than those with normoalbuminuria at baseline. The HR of eGFR for low HDL-C increased rapidly with declining eGFR at <110 ml/min/ 1.73 m2. Subjects with eGFR <60 ml/min/1.73 m2 and 60–<110 ml/min/1.73 m2, respectively, had 3.0-fold and 1.8-fold risks of low HDL-C compared to those with eGFR 110–<140 ml/min/1.73 m2.
Conclusions. In type 2 diabetes, macroalbumninuria predicts high TC and high LDL-C, while reduced renal function, even within normal range, predicts low HDL-C.
Keywords: albuminuria; Chinese; dyslipidaemia; Hong Kong; renal function
Received for publication: 7.12.07
Accepted in revised form: 25. 2.08