title: Dysglycemia but not lipids is associated with abnormal urinary albumin excretion in diabetic kidney disease: a report from the Kidney Early Evaluation Program (KEEP).
abstract: BACKGROUND
  The relationship between glycemic control and lipid abnormalities with urinary albumin-creatinine ratio (ACR) in chronic kidney disease (CKD) patients with diabetes mellitus (DM) is unknown. We sought to investigate the association of dyslipidemia and glycemic control with levels of albuminuria in the National Kidney Foundation (NKF) Kidney Early Evaluation Program (KEEP) participants with DM and CKD stage 3 or higher.
  
  
  METHODS
  We performed a cross-sectional study of 6639 eligible KEEP patients with DM and CKD Stage 3 to 5 from June 2008 to December 2009. Multivariate logistic regression was used to evaluate the association of lipid parameters (per 10 mg/dl change in serum level) and glycosylated hemoglobin (HbA1c) values with three degrees of albuminuria normo (<30 mg/g), micro (30 to 300 mg/g) and macro (>300 mg/g).
  
  
  RESULTS
  2141 KEEP participants were included. HbA1c levels were strongly associated with micro-albuminuria (compared to normo-albuminuria) and macro-albuminuria (compared to normo-albuminuria and micro-albuminuria). Each 1.0% increase in HbA1c increased the odds of micro-albuminuria by 32% (OR 1.32, 95% CI 1.23-1.42) and the odds of macro-albuminuria (vs. microalbuminuria) by 16% (OR 1.16, 95% CI 1.05-1.28). Only increases in serum HDL were associated with decreased odds of micro-albuminuria; otherwise, the association between other components of the serum lipid profile with urinary ACR did not reach statistical significance.
  
  
  CONCLUSIONS
  In this cross-sectional study of 2141 KEEP participants with DM and CKD stages 3-5, overall glycemic control but not lipids were associated with abnormal urinary albumin excretion, a marker of increased risk for progressive disease.
authors.affiliation: Department of Nephrology, Temple University Hospital, Philadelphia, PA, USA. drsbose@gmail.com
authors.forename: Subhasish
authors.initials: S
authors.lastname: Bose
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Bomback
authors.forename: Nehal N
authors.initials: NN
authors.lastname: Mehta
authors.forename: Shu-Cheng
authors.initials: SC
authors.lastname: Chen
authors.forename: Suying
authors.initials: S
authors.lastname: Li
authors.forename: Adam
authors.initials: A
authors.lastname: Whaley-Connell
authors.forename: Joseph
authors.initials: J
authors.lastname: Benjamin
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
mesh_terms: D000419:Albuminuria; D015897:Comorbidity; D003928:Diabetic Nephropathies / Q000097:blood* / Q000453:epidemiology / Q000652:urine*; D050171:Dyslipidemias / Q000097:blood* / Q000453:epidemiology / Q000652:urine*; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000453:epidemiology / Q000652:urine*; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology
chemical_list: D008055:Lipids