Serum Lipids and the Progression of Nephropathy in Type 1 Diabetes

OBJECTIVE — Dyslipidemia contributes to the progression of microvascular disease in dia-betes. However, different lipid variables may be important at different stages of nephropathy. This study examines the pattern of dyslipidemia associated with the progression of nephropathy in patients with type 1 diabetes. RESEARCH DESIGN ANDMETHODS — A total of 152 patients with type 1 diabetes were recruited in order to represent various phases of nephropathy. Patients were followed for 8–9 years, during which time they received standard care. Renal progression was defined a priori as a doubling in albumin excretion (in patients with normo- or microalbuminuria) or a decline in creatinine clearance (in those with macroalbuminuria). A panel of lipid variables was deter-mined and correlated with indexes of progression. RESULTS — In patients with normoalbuminuria (n 66), progression was associated with male sex (P 0.05), borderline albuminuria (P 0.02), and LDL-free cholesterol (P 0.02). In patients with microalbuminuria (n 51), progression was independently associated with triglyceride content of VLDL and intermediate-density lipoprotein (both P 0.05). In patients with macroalbuminuria (n 36), a significant decline in the renal function (3 ml min