(081) Visit-to-visit lipid variability and risk of renal outcomes among patients with type 2 diabetes

Background

Nearly half of patients with type 2 diabetes (T2D) are expected to develop diabetic kidney disease (DKD), the leading cause of kidney failure and end-stage renal disease (ESRD). Hence, it is critical to identify modifiable risk factors for development of DKD in this population. Lipid variability has been well-recognized as an independent predictor for cardiovascular and cerebrovascular diseases, while existing evidence regarding the association of lipid variability with renal disease remains conflicting.

Objective

To examine the association of long-term variability of low-density lipoprotein (LDL) with the risk of renal complications among patients with T2D.

Methods

This study utilized Taiwan National Cheng Kung University Hospital’s electronic health records in 2011-2020. Patients diagnosed with T2D and having at least three LDL were included in study cohort. Index date was defined as the date of the third LDL record. Those without at least one eGFR record before and after the index date or having ESRD prior to the index date were excluded. Renal outcomes included a sustained 30% decline in eGFR and sustained eGFR less than 15 mL/min/1.73m2. LDL variability was determined using standard deviation, coefficient of variation, average real variability, and variability independent of mean. Incidence rate of renal event was calculated as dividing the number of renal events by the total follow-up time (in person-year). Cox proportional hazard model adjusted for potential confounders were utilized to assess the association between LDL variability and renal outcomes. Concordance statistics was applied to evaluate the goodness-of-fit for each model.

Results

A total of 15,444 patients were included, with 54% male, a mean age of 62 years, eGFR of 84.2 mL/min/1.73m2, and HbA1c of 7.5%. During a mean follow-up of 5.3 years, the cumulative incidence rates were 5.04 and 1.16 per 100 person-year for a sustained 30% decline in eGFR and sustained eGFR less than 15 mL/min/1.73m2, respectively. Increased renal event risks with higher level of visit-to-visit LDL variability were observed across different variability indices, except the coefficient of variation and variability independent of mean for renal outcome of a sustained 30% decline in eGFR.

Conclusions
Visit-to-visit LDL variability may be an independent risk factor for development of kidney diseases among patients with T2D, highlighting the importance of classifying patients with a high risk of renal diseases for optimizing individualized medicine.