Association of high serum triglycerides and triglycerides/ HDL ratio with raised HbA1c, creatinine, microalbuminuria and development of diabetic kidney disease and diabetic renal failure. Mathematical and statistical regression models of 10,370 diabetic patients

Author(s): Kamran Mahmood Ahmed Aziz*

Renal disorders and chronic kidney disease (CKD) in diabetics, or the diabetic kidney disease (DKD), renal failure and end stage renal disease (ESRD) still remains most important complications of diabetes with high prevalence. Apart from hyperglycemia, causes and risk factors must be analyzed to reduce the economic burden. Current research was conducted to study the triglycerides and triglycerides to HDL-C ratio (TG/HDL) and their involvement in the development of proteinuria/nephropathy, raising creatinine levels (CKD/DKD). 10,370 Diabetic Patients were recruited in the study for more than 12 years, from 2005 until 2017. 6201 (59.8% were males and 4169 (40.2%) females. 3940 (38%) subjects demonstrated nephropathy while 1348 (13%) demonstrated DKD/CKD. HbA1c was significantly correlated with triglycerides and TG/HDL ratio and microalbumin (p<0.0001, 0.021 and <0.0001, respectively). Triglycerides and TG/HDL were also highly correlated with creatinine and micoalbumin (p=0.006, p=0.002, p<0.0001 and p<0.0001 respectively). Levels of HbA1c, triglycerides, TG/HDL and creatinine were elevated among the patients with nephropathy (p-values: 0.001, 0.001, 0.004, <0.0001, respectively). Similarly, Levels of HbA1c, triglycerides, TG/HDL and microalbuminuria were elevated among the patients with DKD (p-values: 0.03, 0.018, 0.009, <0.0001. Regression models were also developed to demonstrate the effect of dyslipidemia or elevated serum triglycerides in raising the serum creatinine and urine microalbumin levels and development of DKD; all regression models were significant (p<0.0001). For diagnostic statistics, Receiver Operating Curve (ROC) was constructed. The ROC for triglycerides and nephropathy demonstrated area under the curve (AUC) 0.559 (95% CI 0.530 to 0. 588; p-value<0.0001). By this observation and data analysis, for the detection of the development of nephropathy, a triglyceride cutoff point of 138 mg/dl with 65% sensitivity and 55% specificity was observed. Similarly, ROC for detection of DKD, a triglyceride cutoff point of 153 mg/dl with 60% sensitivity and 61% specificity was found (AUC 0.581; 95% CI 0.522 to 0.640; p-value<0.0001). Study findings concluded and recommended that all diabetic patients should be screened for the dyslipidemia and nephropathy to prevent DKD and ESRD.

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