The Association of Postprandial Triglyceride Variability with Renal Dysfunction and Microalbuminuria in Patients with Type 2 Diabetic Mellitus A Retrospective and Observational Study.

Objective: We aim to examine whether day-to-day variation of lipid profile, especially triglyceride (TG) variability, is associated with exacerbation of diabetic kidney disease. Methods: We conducted a retrospective and observational study. First, 527 patients with type 2 diabetes mellitus (DM) who checked estimated glomerular filtration rate (eGFR) every 6 month since 2012 for longer than 5 years, were registered. Variability in postprandial TG was determined using standard deviation (SD), SD adjusted (Adj-SD) for the number of measurements, and maximum minus minimum difference (MMD) during the first 3-year follow up, respectively. The endpoint was 40% and more decline from baseline in eGFR, initiation of dialysis or death. Next, 181 patients who had no micro- nor macro-albuminuria in February 2013, were selected out of the 527 patients. The endpoint was the incidence of micro-albuminuria, initiation of dialysis or death. Results: Among 527 participants, 110 participants reached 40% and more decline from baseline in eGFR, or death. Renal survival was lower in the higher SD, higher Adj-SD and higher MMD groups than in the lower SD, lower Adj-SD and lower MMD groups, respectively (Log-rank test p=0.0073, 0.0059 and 0.0195, respectively). Lower SD, lower Adj-SD, lower MMD were significantly associated with renal survival rate in the adjusted model (hazard ratio, 1.62, 1.66, 1.59; 95% confidence intervals, 1.05-2.53, 1.08-2.58, 1.04-2.47, respectively). Next, among 181 participants, 108 participants developed micro-albuminuria or death. The non-incidence of micro-albuminuria was lower in the higher SD, higher Adj-SD and higher MMD groups than in the lower SD, lower Adj-SD and lower MMD groups, respectively (Log-rank test p=0.0241, 0.0352, and 0.0474, respectively). Conclusions: Postprandial TG variability is a novel risk factor for eGFR decline and incidence of micro-albuminuria in patients with type 2 DM.