Effective dyslipidemia management may help preserve kidney function in individuals with diabetes: Study

Lipid abnormalities are a common complication in diabetic kidney disease (DKD), contributing to disease progression and increasing cardiovascular risks. The researchers note that managing dyslipidemia in DKD is crucial, but conventional lipid-lowering therapies such as statins and fibrates have limitations, particularly concerning renal safety. Studies have linked dyslipidemia to an increased risk of atherosclerotic cardiovascular disease (ASCVD) and the progression of diabetic kidney disease, highlighting the potential role of early lipid management in preserving renal function.

Qian Ming Tu, Department of General Medicine, Shanghai Putuo District Changzheng Town Community Health Service Center, Shanghai, China, and colleagues conducted a retrospective study to explore the clinical characteristics of dyslipidemia, the mechanisms of lipid-induced renal injury, and recent advancements in lipid-lowering therapies for DKD.

For this purpose, the researchers conducted a literature search in PubMed, Web of Science, and EMBASE using specific keywords such as “diabetic kidney disease,” “diabetic nephropathy,” “diabetes,” “dyslipidemia,” “kidney,” “cardiovascular disease,” and “lipid therapy.”

Key Findings:

• High triglyceride (TG) levels and low high-density lipoprotein (HDL) levels were associated with an increased risk of albuminuria and a decline in the estimated glomerular filtration rate (eGFR).
• Abnormal lipid metabolism led to glomerular podocyte and renal tubular epithelial cell damage through ectopic lipid deposition, impairing filtration and increasing urinary albumin excretion.
• Lipid-lowering therapies reduced lipid accumulation suppressed inflammatory mediators, and mitigated renal fibrosis.
• Fibrates and statins helped lower albuminuria and slowed eGFR decline in early diabetic kidney disease (DKD), though their long-term impact on renal outcomes remained uncertain.
• Pro-protein convertase subtilisin/kexin 9 (PCSK9)-targeted treatments had fewer renal side effects and were more effective in reducing inflammation and improving kidney function compared to statins and fibrates.

The authors emphasized the importance of lipid management in diabetic kidney disease, highlighting that abnormal lipid metabolism can impair renal function. While lipid-lowering therapies help reduce inflammation and slow renal decline, the long-term effects of statins and fibrates remain uncertain. They noted that PCSK9-targeted treatments provide a safer alternative with better renal outcomes.

They further stated, "LDL apheresis and double filtration plasmapheresis show promise for patients with severe hypercholesterolemia or drug intolerance."

"Given the variability in lipid profiles among DKD patients, personalized treatment strategies are essential to optimize renal outcomes and improve disease management," they concluded.

Reference:

Tu, Q. M., Jin, H. M., & Yang, X. H. (2025). Lipid abnormality in diabetic kidney disease and potential treatment advancements. Frontiers in Endocrinology, 16, 1503711. https://doi.org/10.3389/fendo.2025.1503711