Prospective study of lipoprotein(a) as a risk factor for deteriorating renal function in type 2 diabetic patients with overt proteinuria.
OBJECTIVE
The effect of lipoprotein(a) [Lp(a)] on the progression of diabetic nephropathy has not been evaluated yet. The aim of this study was to determine whether Lp(a) is an independent risk factor for deteriorating renal function in type 2 diabetic patients with nephropathy.


METHODS
We conducted this prospective study in type 2 diabetic patients with overt proteinuria. Patients were divided into two groups according to their baseline serum Lp(a) level. Group 1 had Lp(a) levels < or =30 mg/dl (n = 40) and group 2 had Lp(a) levels >30 mg/dl (n = 41). Patients were followed for 2 years. Progression of diabetic nephropathy was defined as a greater than twofold increase of follow-up serum creatinine concentration from the baseline value.


RESULTS
At baseline and during the follow-up, there was no difference in HbA(1c) and lipid profile between groups 1 and 2. However, serum creatinine was significantly higher in group 2 than in group 1 after 1 year (148.3 +/- 78.0 vs. 108.1 +/- 34.9 micromol/l, P = 0.004) and after 2 years (216.9 +/- 144.5 vs. 131.3 +/- 47.3 micromol/l, P = 0.001), although baseline serum creatinine did not differ significantly between groups. In all, 13 of 14 patients with progression of diabetic nephropathy (progressors) were from group 2. Baseline Lp(a) levels were higher in the progressors than in the nonprogressors (62.9 +/- 26.7 vs. 33.5 +/- 27.5 mg/dl, P < 0.001). Multiple logistic regression showed that baseline Lp(a) level was a significant and independent predictor of the progression of diabetic nephropathy.


CONCLUSIONS
Our study demonstrated that Lp(a) is an independent risk factor for the progression of diabetic nephropathy in type 2 diabetic patients with overt proteinuria.
Song
Ki-Ho
KH
Department of Internal Medicine, Catholic University of Korea, Seoul, Korea. kihos@catholic.ac.kr
Ko
Seung Hyun
SH
Kim
Hyung-Wook
HW
Ahn
Yu-Bae
YB
Lee
Jong-Min
JM
Son
Hyun-Shik
HS
Yoon
Kun-Ho
KH
Cha
Bong-Yun
BY
Lee
Kwang-Woo
KW
Son
Ho-Young
HY
D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000652:urine; D003928:Diabetic Nephropathies / Q000097:blood*; D018450:Disease Progression; D005260:Female; D006801:Humans; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011507:Proteinuria; D012307:Risk Factors
D015415:Biomarkers; D017270:Lipoprotein(a); D003404:Creatinine