Association Between Triglycerides and Incident Chronic Kidney Disease in Diabetics Across Stages of Albuminuria

Background: Hypertriglyceridemia, a component of the metabolic syndrome, is a known independent predictor of albuminuria and chronic kidney disease (CKD) in the general population. Urine albumin to creatinine ratio (UACR) and albuminuria are critical components in CKD staging as well as a hallmark of diabetic kidney disease. We sought to evaluate the relationship of triglycerides (TG) with incident CKD in diabetic non-CKD patients, stratified by level of albuminuria, which has been less studied thus far. Methods: This study comprised of 99,705 diabetic non-CKD veterans with data on TG and MetS components. The incident CKD outcome was defined as multiple eGFR measurements of <60 mL/min/1.73m 2 at least 90 days apart. Using Cox proportional hazards models, we evaluated the association of TG with incident CKD, adjusted for case-mix characteristics, laboratory values including hemoglobin A1c, and stratified by baseline albuminuria categories. Results: The mean±SD age was 63±10, with a median [IQR] for TG of 147[99, 222] mg/dL, and UACR <30 mg/g for 76% of patients. We observed a slight linear association between TG and incident CKD after adjustment for case-mix and laboratory variables among patients with Alb A1 and A2 stages (<30 and 30-300 mg/g) (ref: TG 120-<160 mg/dL) (Figure). While low TG were associated with a lower risk of incident CKD, elevated TG ≥240 mg/dL trended towards a higher risk of event. Among Alb A3 patients (>300 mg/g), we observed an inverse U shape, where elevated TG ≥240 mg/dL trended towards a lower risk of incident CKD after adjustment. Conclusion: Elevated TG were associated with a higher risk of incident CKD in diabetic non-CKD patients with normal microalbuminuria. Patients with higher levels of albuminuria trended towards a lower relationship. Additional study is warranted to investigate the mechanism behind diabetic kidney disease risk with consideration for levels of albuminuria.