title: Plasma lipoprotein(a) levels are associated with mild renal impairment in type 2 diabetics independent of albuminuria.
abstract: BACKGROUND
  CKD, an independent risk factor for CV disease, increases mortality in T2DM. Treating modifiable CV risk factors decreases mortality in diabetics with microalbuminuria, but the role of early CV prevention in diabetics with mild CKD by GFR criteria alone remains unclear. The purpose of this study was to probe whether T2DM patients with mild GFR impairment have atherogenic lipid profiles compared to diabetic counterparts with normal renal function.
  
  
  METHODS
  In the Penn Diabetes Heart Study (PDHS), a single-center observational cohort of T2DM patients without clinical CVD, cross-sectional analyses were performed for directly measured lipid fractions in 1852 subjects with eGFR>60 mL/min/1.73 m² determined by the CKD-EPI equation (n = 1852). Unadjusted and multivariable analyses of eGFR association with log-transformed lipid parameters in incremental linear and logistic regression models (with eGFR 90 mL/min/1.73 m² as a cut-point) were performed.
  
  
  RESULTS
  Mild GFR impairment (eGFR 60-90 mL/min/1.73 m², median urinary ACR 5.25 mg/g) was associated with higher log-transformed Lp(a) values (OR 1.17, p = 0.005) and with clinically atherogenic Lp(a) levels above 30 mg/dL (OR 1.35, p = 0.013) even after full adjustment for demographics, medications, metabolic parameters, and albuminuria. Logistic regression demonstrated a trend towards significance between worse kidney function and apoB (p = 0.17) as well as apoC-III (p = 0.067) in the fully adjusted model.
  
  
  CONCLUSIONS
  Elevated Lp(a) levels have a robust association with mild GFR impairment in type 2 diabetics independent of race, insulin resistance, and albuminuria.
authors.affiliation: Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America.
authors.forename: Jennie
authors.initials: J
authors.lastname: Lin
authors.affiliation: Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America.
authors.forename: Muredach P
authors.initials: MP
authors.lastname: Reilly
authors.affiliation: Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America.
authors.forename: Karen
authors.initials: K
authors.lastname: Terembula
authors.affiliation: Section of Nephrology, Program of Applied Translational Research Department of Medicine, Yale School of Medicine, Yale University, New Haven, CT, United States of America.
authors.forename: F Perry
authors.initials: FP
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000150:complications*; D053305:Apolipoprotein C-III / Q000097:blood; D001055:Apolipoproteins B / Q000097:blood; D050197:Atherosclerosis / Q000097:blood / Q000150:complications; D015243:Cholesterol, VLDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000097:blood* / Q000150:complications* / Q000503:physiopathology; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D014280:Triglycerides / Q000097:blood
chemical_list: D053305:Apolipoprotein C-III; D001055:Apolipoproteins B; D015243:Cholesterol, VLDL; D017270:Lipoprotein(a); D014280:Triglycerides