Open Access Open Badges Research article

Dysglycemia but not lipids is associated with abnormal urinary albumin excretion in diabetic kidney disease: a report from the Kidney Early Evaluation Program (KEEP)

Subhasish Bose1*, Andrew S Bomback2, Nehal N Mehta3, Shu-Cheng Chen4, Suying Li4, Adam Whaley-Connell5, Joseph Benjamin1, Peter A McCullough6 and KEEP investigators

Author Affiliations

1 Department of Nephrology, Temple University Hospital, Philadelphia, PA, USA

2 Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY, USA

3 Cardiovascular Institute, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

4 Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA

5 Dept of Internal Medicine, Division of Nephrology, Harry S Truman VA Medical Center and University of Missouri-Columbia School of Medicine, Columbia, MO, USA

6 St. John Providence Health System, Providence Park Heart Institute, Novi, MI, USA

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BMC Nephrology 2012, 13:104  doi:10.1186/1471-2369-13-104

Published: 7 September 2012



The relationship between glycemic control and lipid abnormalities with urinary albumin-creatinine ratio (ACR) in chronic kidney disease (CKD) patients with diabetes mellitus (DM) is unknown. We sought to investigate the association of dyslipidemia and glycemic control with levels of albuminuria in the National Kidney Foundation (NKF) Kidney Early Evaluation Program (KEEP) participants with DM and CKD stage 3 or higher.


We performed a cross-sectional study of 6639 eligible KEEP patients with DM and CKD Stage 3 to 5 from June 2008 to December 2009. Multivariate logistic regression was used to evaluate the association of lipid parameters (per 10 mg/dl change in serum level) and glycosylated hemoglobin (HbA1c) values with three degrees of albuminuria normo (<30 mg⁄g), micro (30 to 300 mg⁄g) and macro (>300 mg⁄g).


2141 KEEP participants were included. HbA1c levels were strongly associated with micro-albuminuria (compared to normo-albuminuria) and macro-albuminuria (compared to normo-albuminuria and micro-albuminuria). Each 1.0% increase in HbA1c increased the odds of micro-albuminuria by 32% (OR 1.32, 95% CI 1.23-1.42) and the odds of macro-albuminuria (vs. microalbuminuria) by 16% (OR 1.16, 95% CI 1.05-1.28). Only increases in serum HDL were associated with decreased odds of micro-albuminuria; otherwise, the association between other components of the serum lipid profile with urinary ACR did not reach statistical significance.


In this cross-sectional study of 2141 KEEP participants with DM and CKD stages 3–5, overall glycemic control but not lipids were associated with abnormal urinary albumin excretion, a marker of increased risk for progressive disease.

Chronic Kidney Disease; Diabetes Mellitus; Proteinuria; Dyslipidemia; Glycosylated hemoglobin