Serum Lipids and Risk of Rapid Renal Function Decline in Treated Hypertensive Adults With Normal Renal Function.

BACKGROUND: We aim to evaluate the effect of different lipids parameters, including triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), the TG to HDL-C (TG:HDL-C) ratio, total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C), on the risk of rapid renal function decline and examine any possible effect modifiers in general hypertensive patients with normal renal function. METHODS: A total of 12,549 hypertensive patients with estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m2 in the renal sub-study of the China Stroke Primary Prevention Trial were included in the analyses. The primary outcome was rapid renal function decline, defined as an average decline in eGFR ≥ 5 ml/min/1.73 m2 per year. RESULTS: The median treatment duration was 4.4 years. After the full adjustment for TC, TG, HDL-C, and other major covariates, a significantly higher risk of rapid renal function decline was found in participants with higher TG [≥150 vs. <150 mg/dl, 7.7% vs. 5.5%; odds ratios (OR): 1.27; 95% confidence interval (CI): 1.06-1.51], higher TG:HDL-C ratio [≥2.7 (median) vs. <2.7, 7.7% vs. 5.0%; OR: 1.39; 95% CI: 1.14-1.71), lower TC (≥200 vs. <200 mg/dl, 6.0% vs. 7.0%; OR: 0.79; 95% CI: 0.67-0.93), or lower LDL-C levels (≥130 vs. <130 mg/dl, 6.1% vs. 7.0%; OR: 0.79; 95% CI: 0.67-0.94). Moreover, the increased risk of the primary outcome associated with elevated TG was particularly evident among individuals with lower total homocysteine levels [<12.4 (median) vs. ≥ 12.4 µmol/l, P interaction = 0.036]. CONCLUSIONS: Higher TG and TG:HDL-C ratio were independent risk factors for rapid renal function decline in hypertensive adults with normal renal function.

Relationship of diabetes with renal dysfunction in hypertensive adults.

We aimed to examine the relationship of diabetes with the estimated glomerular filtration rate (eGFR)-based renal function in the Chinese hypertensive adults.This cross-sectional analysis included a total of 18,641 hypertensive adults aged 45 to 75 years. The relationship of diabetes (a fasting glucose ≥7.0 mmol/L or self-reported use of hypoglycemic agents or physician diagnosed diabetes) with glomerular hyperfiltration (an absolute eGFR >90th percentile after adjusting for sex, age), hypofiltration (an eGFR <10th percentile and ≥60 mL/min/1.73 m), and reduced eGFR (an eGFR <60 mL/min/1.73 m) were estimated by multiple logistic regressions.Both the cut-points for hyperfiltration and hypofiltration decreased with age increased, ranging from 115 to 91 mL/min/1.73 m and 91 to 67 mL/min/1.73 m, respectively. In the multiple logistic models, diabetes was positively associated with glomerular hyperfiltration (odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.93-2.47), hypofiltration (1.24, 1.05-1.46), and reduced eGFR (2.88, 2.21-3.76). Furthermore, the stronger association between diabetes and hyperfiltration was found in those with younger age (P for interaction <.001), or higher total cholesterol (TC) levels (P for interaction = .008). Consistently, significant association between diabetes and hypofiltration was only observed in participants with younger age (P for interaction = .043). And detrimentally interaction between diabetes and higher TC levels was also found (P for interaction <.001) on the risk of reduced eGFR.Diabetes was significantly associated with the impairment of renal function, particularly in those with younger age or with higher TC levels. Fasting glucose should be monitored as a marker to identify those with early renal dysfunction.