Correlation Between High Density Lipoprotein Cholesterol And Kidney Function In Type 1 Diabetes Mellitus As A Predictor Of Diabetic Nephropathy In Human Subjects

ABSTRACT

Diabetic nephropathy (DN) is a common microvascular complication occurring five years from onset of type 1 diabetes mellitus, leading to renal failure and death. It is characterized by albuminuria and a reduced glomerular filtration rate. Although much emphasis has been placed on screening for albuminuria and estimated glomerular filtration rate (eGFR) to predict or diagnose DN, less attention has been focused on the role of high density lipoprotein cholesterol (HDL-C) in risk assessment of DN onset. The aim of the present study was to evaluate the association between HDL-C levels and the markers of kidney functions, urinary albumin creatinine ratio (UACR) and eGFR, in patients with type 1 diabetes mellitus. In total, 89 type 1 diabetic mellitus patients attending Kenyatta National Hospital were recruited. A questionnaire was administered to ascertain age, gender, marital status, education level, family history of kidney disease and the diabetes duration. The following parameters were measured: blood pressure, body mass index, UACR, eGFR, total and HDL cholesterol. Data analysis was done using SPSS version 20.0. Chi squared test was used to analyse categorical variables of states of UACR, HDL-C and eGFR against the demographic and clinical risk factors. While for analysis of between group continuous variables, t test, one way ANOVA and Pearson correlation statistics were applied. The values of UACR, HDL-C and eGFR levels in the study population ranged from 3–300 mg/g, 0.45–3.45 mmol/l and 29.1–240.5 ml/min/1.73m2 , respectively. The number of participants with abnormal levels of UACR, HDL-C and eGFR were 45%, 14%, and 22%, respectively. The UACR and HDL-C values were significantly associated with the risk factors of: duration of diabetes, systolic and diastolic blood pressure (p < 0.05). The confounding factor of marital status was only significantly associated with UACR levels. On the other hand eGFR was not associated with any of the patients tested characteristics (p > 0.05). The HDL-C values were significantly lower in the subjects with albuminuria compared to normoalbuminuric group (p = 0.001). There was no significant association or correlation between HDL-C and eGFR values (r = 0.029; p > 0.05). Therefore, eGFR does not add predictive value of diabetic nephropathy among patients with type 1 diabetes mellitus. However, there was a significant inverse correlation between HDL-C and UACR level (r = -0.394; p < 0.05). Therefore, HDL-C has the potential to alternately predict the development of nephropathy levels among patients with a long standing case of type 1 diabetes mellitus.