HYPERCHOLESTEROLEMIA-A DETERMINANT OF RENAL-FUNCTION LOSS AND DEATHS IN IDDM PATIENTS WITH NEPHROPATHY

The development of kidney disease in diabetes mellitus can be viewed a s a two-stage process: (1) the development of proteinuria, and (2) its progression to chronic renal failure. Determinants of the latter were examined in 439 IDDM patients who had nephropathy and participated in the Diabetic Retinopathy Study. Using serum creatinine levels obtaine d during the follow-up period to assess the rate of loss of renal func tion, we found that only one-third of these patients experienced a rap id loss of function, while the others had slowly declining or unchangi ng renal function despite the presence of proteinuria and severe diabe tic retinopathy. Among the many baseline variables examined, only elev ated cholesterol and elevated systemic blood pressure were predictors of a rapid loss of renal function. Patients with this rapid loss of re nal function also had the highest risk of death due to cardiovascular causes, as well as all causes. Once again, hypercholesterolemia was th e major predictor of these deaths. In conclusion, efforts should be un dertaken early to identify patients who are rapidly losing renal funct ion so that interventions to modify systemic blood pressure and hyperc holesterolemia may prevent or postpone the development of renal failur e and death in patients with IDDM.