Plasma lipids and risk of developing renal dysfunction: The Atherosclerosis Risk in Communities Study

Background. Animal and in vitro data suggest that dyslipidemia plays an imp ortant rule in the initiation and progression of chronic renal disease, but few prospective studies have been conducted in humans. Methods. We studied the relationship of plasma lipids to a rise in serum cr eatinine of 0.4 mg/dL or greater in 12,728 Atherosclerosis Risk in Communit ies (ARIC) participants with baseline serum creatinine that was less than 2 .0 mg/dL in men and less than 1.8 mg/dL in women. Results. During a mean follow-up of 2.9 years, 191 persons had a rise in cr eatinine of 0.4 mg/dL or greater, yielding an incidence rate of 5.1 per 100 0 person years. Individuals with higher triglycerides and lower high-densit y lipoprotein (HDL) and HDL-2 cholesterol at baseline were at increased ris k for a rise in creatinine after adjustment for race, gender, baseline age, diabetes, serum creatinine, systolic blood pressure, and antihypertensive medication use (all P trends less than or equal to 0.02). The adjusted rela tive risk for the highest versus lowest quartile of triglycerides was 1.65 (95 % CI, 1.1, 2.5, P = 0.01) and for HDL was 0.47 (95% CI, 0.3, 0.8, P = 0 .003). These associations were significant in participants with normal crea tinine (defined as < 1.4 mg/dL for men and < 1.2 mg/dL for women), with dia betes, and without diabetes. The effect of high triglycerides was independe nt of plasma glucose, but was weaker and less consistent after further adju stment for fasting insulin in nondiabetics. Conclusions. High triglycerides and low HDL cholesterol, but not low-densit y lipoprotein in cholesterol, predict an increased risk of renal dysfunctio n. The treatment of these lipid abnormalities may decrease the incidence of early renal disease.