title: Serum lipopolysaccharide activity is associated with the progression of kidney disease in finnish patients with type 1 diabetes.
abstract: OBJECTIVE
  The aim of the study was to investigate whether serum lipopolysaccharide (LPS) activities are associated with the progression of kidney disease in patients with type 1 diabetes.
  
  
  METHODS
  For this prospective study, we chose 477 Finnish patients with type 1 diabetes, who were followed for 6 years. At the baseline visit, 239 patients had a normal albumin excretion rate (normoalbuminuria) and 238 patients had macroalbuminuria. Patients were further divided into nonprogressors and progressors based on their albumin excretion rate at follow-up. Eighty normoalbuminuric patients had developed microalbuminuria, and 79 macroalbuminuric patients had progressed to end-stage renal disease. Serum LPS activity was determined with the Limulus amoebocyte lysate chromogenic end point assay.
  
  
  RESULTS
  Serum LPS activity was significantly higher in the macroalbuminuric group than in the normoalbuminuric group (P < 0.001). Notably, normoalbuminuric progressor patients had a significantly higher LPS activity at baseline than normoalbuminuric nonprogressor patients (median 49 [interquartile range 34-87] vs. 39 [29-54] EU/ml; P = 0.001). The normoalbuminuric progressor patients exhibited features of the metabolic syndrome with higher triglyceride concentrations and lower estimated glucose disposal rate. A high LPS-to-HDL ratio was associated with the progression of kidney disease in both groups. Insulin resistance (P < 0.001) and serum LPS activity (P = 0.026) were independent risk factors of disease development, when A1C was removed from the regression analysis.
  
  
  CONCLUSIONS
  High serum LPS activity is associated with the development of diabetic nephropathy in Finnish patients with type 1 diabetes.
authors.affiliation: Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Finland.
authors.forename: Mariann
authors.initials: M
authors.lastname: Nymark
authors.forename: Pirkko J
authors.initials: PJ
authors.lastname: Pussinen
authors.forename: Anita M
authors.initials: AM
authors.lastname: Tuomainen
authors.forename: Carol
authors.initials: C
authors.lastname: Forsblom
authors.forename: Per-Henrik
authors.initials: PH
authors.lastname: Groop
authors.forename: Markku
authors.initials: M
authors.lastname: Lehto
mesh_terms: D000328:Adult; D017668:Age of Onset; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications; D003928:Diabetic Nephropathies / Q000097:blood / Q000473:pathology; D005260:Female; D005387:Finland; D006801:Humans; D007674:Kidney Diseases / Q000097:blood* / Q000473:pathology*; D008070:Lipopolysaccharides / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D008070:Lipopolysaccharides