A-244 Association between dyslipidemia and increased albuminuria in type 1 diabetes

Abstract Background Early onset diabetic nephropathy (DN) is screened using moderately increased albuminuria. At this stage, DN can be slowed and stopped with converting enzyme inhibitors (CEI). If ignored, it may progress to chronic renal failure. At this late stage, hypercholesterolemia is listed as one of the main predictors of death in type 1 diabetic patients. The mechanism associating DN and dyslipidemia is not yet clearly established. It can be linked to a renal leakage of cofactors involved in lipoproteins metabolism. Therefore, dyslipidemia would be present at the onset of DN due to the presence of glomerulopathy. The aim of this study was to ascertain whether dyslipidemia is present at the early stage of diabetic nephropathy in type 1 diabetes. Methods This was a cross-sectional analytical study. Known type 1 diabetic patients were recruited at random. Glycemia, triglyceridemia (TG) and plasma total cholesterol (TC) were determined using enzymatic methods, HDL-cholesterolemia (HDL-C) using the magnesium phosphotungstate selective precipitation method, LDL-cholesterolemia (LDL-C) using Friedewald formula. Glycated hemoglobin (HbA1c) was assayed using enzyme immunoassay and albuminuria using immunoturbidimetry. Creatinine was measured in serum and urine using the non-enzymatic Jaffé method. Creatinine levels were used to estimate glomerular filtration rate (GFR) using the Schwartz formula, and creatinine levels were used to calculate the urine albumin/creatinine ratio (ACR). The proportion of abnormal values was determined for each parameter in the overall population and in the group of patients with increased albuminuria. Univariate and multivariate analysis was also performed to capture the effect of albuminuria on each lipid parameter after adjustment for age, gender, blood glucose, HbA1c and GFR. Test significance was set at p < 0.05. Results A total of 234 type 1 diabetic patients were included in this study with a mean age of 14.78±4.63 years [minimum - maximum: 3 - 24] and a female frequency of 53.51% (n=122). Mean glycemia was 187±89 mg/dl. HbA1c was increased in 80% (n=124) of the study population, albuminuria in 35.44%(n=56), TC in 75.58%(n=164), LDL-C in 57.97%(n=120), and TG in 42.72%(n=91). GFR was reduced in 78.34%(n=170) of the study population, and HDL-C in 13.08%(n=28). In the group of patients with increased albuminuria (ACR = 30 mg/g), TC was significantly increased in 85.19%(n=46, p=0.013), LDL-C in 64.15%(n=34, p=0.042) and TG in 40.74%(n=22, p=0.553), while HDL-C was decreased in 11.11%(n=6, p=0.342) compared to the group with normal albuminuria (ACR < 30 mg/g). Albuminuria was a risk factor of increased TC 1.71 (95%CI: 1.22 - 2.40; p=0.002) and increased LDL-C 1.30 (95%CI: 1.009 - 1.68; p=0.043). Albuminuria had no effect on the increase of TG 1.18 (95%CI: 0.92 - 1.52; p=0.186) or on the decrease of HDL-C 0.82 (95%CI: 0.56 - 1.20; p=0.320). Conclusion Dyslipidemia, notably increased TC and LDL-C, is common in our study population. The frequency of this dyslipidemia increases with increased albuminuria. Dyslipidemia, in this group of patients may be linked to urinary leakage of cofactors involved in lipoproteins metabolism. It would be justified to add cholesterol-lowering agents to CEIs when treating early onset nephropathy in type 1 diabetics.