Effects of albuminuria and renal dysfunction on development of dyslipidaemia in type 2 diabetes - the Hong Kong Diabetes Registry

Background. It is uncertain whether albuminuria precedes the future development of high total cholesterol (TC > 6.2 mmol/1) and high LDL-C (> 4.1 mmol/1) while renal dysfunction precedes the future development of low HDL-C (< 0.9 mmol/1) in type 2 diabetes. Methods. A prospective cohort of 2761 type 2 diabetic patients without significant dyslipidaemia and having at least one measurement of TC, LDL-C and HDL-C during 2.8 years of follow-up was analysed. The spline Cox regression model was used to derive hazard ratio (HR) curves of the spot urinary albumin:creatinine ratio (ACR) and the estimated glomerular filtration rate (eGFR) for dyslipidaemia, followed by standard Cox models to confirm the findings from the HR Curves. Results. Seven percent of the cohort developed high TC, 4.6% developed high LDL-C and 5.7% developed low HDL-C during follow-up. In multivariate analysis, the HR of ACR for high TC and high LDL-C increased rapidly and linearly from zero with no apparent threshold. Patients with macroalbuminuria (ACR >= 25 mg/mmol) were, respectively, 1.6- and 2.4 folds more likely to develop high TC and high LDL-C than those with normoalbuminuria at baseline. The HR of eGFR for low HDL-C increased rapidly with declining eGFR at < 110 ml/min/ 1.73 m(2). Subjects with eGFR < 60 ml/min/1.73 m(2) and >= 60-< 110 ml/min/1.73 m(2), respectively, had 3.0-fold and 1.8-fold risks of low HDL-C compared to those with eGFR >= 110-< 140 ml/min/1.73 m(2). Conclusions. In type 2 diabetes, macroalbumninuria predicts high TC and high LDL-C, while reduced renal function, even within normal range, predicts low HDL-C.