Low HDL-C level as an independent marker of kidney damage risk in type 2 diabetes
A new study shows that low HDL cholesterol levels in patients with type 2 diabetes increase the risk of severe kidney complications. The results suggest that HDL-C may be an important, independent marker of kidney disease progression.
Dyslipidemia is a recognized cardiovascular risk factor in type 2 diabetes (DM2). However, its impact on the progression of chronic kidney disease remains unclear. Although low HDL cholesterol levels have been associated with the risk of nephropathy, it was unclear whether this directly translates into the most serious consequences of the disease. A new prospective study published in BMJ Open Diabetes Research & Care fills this gap.
Researchers analyzed data from 1,033 DM2 patients, following them for a median of 5.3 years. The goal was to capture the occurrence of major renal events (defined as a decline in eGFR of at least 50% or the development of renal failure requiring renal replacement therapy) and to assess all-cause mortality.
The results point to a key role for HDL-C. After adjusting for numerous clinical variables, patients with the lowest HDL-C values (<42 mg/dL) had a significantly higher risk compared to the group with normal results. Their risk of critical renal events increased more than 2.5-fold (HR 2.61), and their risk of death more than doubled (HR 2.27). Interestingly, other lipid parameters analyzed – including triglycerides (TG), LDL cholesterol, and the TG/HDL-C ratio – did not show a statistically significant association with kidney disease progression or mortality in this study.
For clinical practice, this means that a low HDL-C level should be treated as an important, independent warning sign. It can be used to identify diabetic patients at particular risk of rapid kidney function loss, even if other lipid parameters appear to be controlled.
