Plasma triglycerides as a risk factor for chronic kidney disease in type 2 diabetes mellitus: Evidence from northeastern Thailand

https://doi.org/10.1016/j.diabres.2018.02.011Get rights and content

Highlights

  • Increased plasma triglyceride was associated with a higher risk of CKD among the Thai diabetic population.

  • Study findings suggest to incorporate triglyceride monitoring in routine clinical practices.

  • High TG level could guide physicians to institute early preventive measures to slow CKD progression.

Abstract

Aims

To investigate the observational association between plasma triglyceride and CKD in patients with T2DM.

Methods

A hospital-based retrospective registry was used to obtain data of 3,748 T2DM patients from May 2016 to October 2016. Anthropometric measurements and biochemical reports of T2DM patients with CKD were obtained by data extraction of medical records. CKD was defined according to the estimated glomerular filtration rate (eGFR< 60 mL/min/1.73 m2). Multiple logistic regression was used to determine the association between plasma triglyceride and CKD.

Results

The mean age of the participants was 61.4 ± 11.0 years, and a majority of them was female (64%) with poor glycemic control (83%), increased plasma triglyceride (51%) and 27% of T2DM patients had CKD. There was a significant trend towards deteriorating renal function (lower eGFR) with categorically raised triglyceride levels. After controlling for age, sex and other confounders, ‘borderline high’ (adjusted odds ratio (OR): 1.24, 95% confidence interval (CI): 1.01–1.54), ‘high’ (adjusted OR: 1.52, 95% CI: 1.24–1.85) and ‘very high’ (adjusted OR: 3.40, 95% CI: 1.94–5.94) triglyceride level groups had higher likelihood to have CKD compared to normal triglyceride level.

Conclusion

CKD was associated with a higher level of plasma triglyceride among patients with T2DM. These results support the rationale to screen and manage increased triglyceride in routine clinical practices among persons with diabetes to prevent CKD.

Introduction

Type 2 Diabetes Mellitus (T2DM) has emerged as a global pandemic in recent times [1] and is the tenth most common cause of deaths in South-East Asia [2]. Uncontrolled long-term hyperglycemia due to DM predisposes to acute and chronic vascular complications leading to ischemic heart disease, cerebrovascular disease and chronic kidney disease (CKD) in the form of ‘End stage of renal diseases (ESRD)’ in both the developed and developing countries [3]. The prevalence of CKD as a diabetic microvascular complication (diabetic nephropathy) is quite high in South-East Asia [4]. According to an estimate of the World Bank, diabetes mellitus affected 7.1% of the Thai population in 2015. Substantial geographic variation exists in the prevalence of CKD as well; in general, it is higher in northeast Thailand than other provinces [5] and affected 27% of diabetic patients there in 2008 [6]. A recent study which was conducted in 2015 found that 25.3% patients developed diabetic CKD in northeast Thailand [7]. As far as clinical management is concerned, CKD in diabetic patients massively burdens Thailand’s healthcare system as CKD-related treatments are expensive, and costs are partially covered by the universal care coverage in Thailand [8], [9]. Therefore, diabetic management has emerged as a key issue to prevent diabetic kidney disease and other complications [10]. Moreover, Thailand has adopted the World Health Organization’s (WHO) ‘Global monitoring framework on Non-Communicable Diseases (NCDs)’ and have taken measures to reduce 25% of overall mortality due to DM complications by 2025.

With the advent of the 21st century, many developing countries are experiencing the effects of an epidemiological transition, and Thailand is no exception. The paradigm of disease burden is gradually shifting from infectious diseases like tuberculosis to non-communicable diseases such as diabetes and nephritic diseases. Lifestyle factors and physical inactivity predispose to obesity and are rapidly emerging as major public health problem in the Thai population [11]. Obesity is associated with adverse cardiometabolic disturbances including elevated low-density lipoprotein and plasma triglycerides [12]. However, the distribution of plasma triglyceride was found to be higher (40%) in the northeast Thailand [13]. High triglyceride has been recognized as an independent risk factor for coronary artery diseases and cardio-vascular diseases [14], [15]. But the association of triglyceride concentration and CKD in patients with T2DM is not well studied in Thailand.

High plasma triglyceride is found to be a common lipid abnormality among the pre-dialysis CKD patients. A few hypotheses support the pathophysiology of the overproduction of high triglyceride during the early period of kidney failure [16]. Moreover, the findings of animal testing with rats imply that high lipid concentration might result in proteinuria and focal glomerulosclerosis to develop nephropathy [17]. If CKD is associated with lipid perturbations in DM, it might be a pressing public health concern [2] and hence, would require further in-depth studies. The presence of high triglyceride level can act as screening tools to identify the high-risk diabetic group who are going to develop CKD as a T2DM. It will help physicians to introduce prompt diabetic management. This cross-sectional study investigated the association of plasma triglycerides with CKD among the T2DM patients in Thailand.

Section snippets

Data source

A hospital-based retrospective registry data collection was performed between May 10 and October 1, 2016. The data was collected from a clinical registry of T2DM patients from a large district hospital in northeast Thailand. The hospital has been maintaining a community-based diabetic registry under an ongoing screening program. This hospital is the only secondary referral facility with a catchment of 114,588 population. The study data represented all sample collected in 2015 from the yearly

Results

Among the study participants, the mean age of the patients were 61.4 ± 11.0 years, and the male to female ratio was 1:1.8 (Table 1). Their primary occupation was farming (58.5%) and rest were involved with different types of job. The LDL cholesterol level was within normal range for 79.0% of the T2DM patients. About 55.2% of the patients had hypertension. Majority of the diabetic patients (80.0%) had poor glycemic control (HbA1c > 6.5 mmol/L). Very few participants gave the positive history of

Discussion

The study found a positive relationship between plasma triglyceride concentration and CKD in Thai patients with T2DM. Diabetic patients with ‘very high triglyceride’ were 3.4 times more likely to develop CKD compared to the normal triglyceride (reference) group. To the best of our knowledge, this is the first study to explore the relationship between plasma triglyceride and CKD in Northeastern Thailand.

North-East of Thailand is also known to be connected with the so-called “Renal stone belt”

Conclusions

This study found that plasma triglyceride is independently associated with CKD among the diabetic patients. Our results support the rationale to screen and manage increased triglyceride in routine clinical practices among diabetic patients.

Acknowledgement

We are grateful to the participants and staffs of the participating hospital. We would like to thank Professor Frank P. Schelp and Aj. Pattara Sanchaisuriya for their advice and guidance. We acknowledge the support of German Academic Exchange Service (DAAD) and Charite- University Medicine Berlin to help us in conducting the study.

Funding

There is no source of financing.

Author’s contribution

Conceptualization: SBZ, NH. Data Collection: SBZ, NH. Methodology: SBZ, MAK, NH. Data Analysis: SBZ, MAK, GMAK, SMSI. Writing – Original draft: SBZ, MAK, NH, GMAK, SMSI. Writing – Review & Editing: SBZ, MAK, NH, GMAK, SMSI.

Conflict of interest

The authors declare that there is no conflict of interests.

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