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Meta-Analysis
. 2021 Mar 24:12:633529.
doi: 10.3389/fendo.2021.633529. eCollection 2021.

Association Between Lipoprotein (A) and Diabetic Nephropathy in Patients With Type 2 Diabetes Mellitus: A Meta-Analysis

Xiaoyan Ren  1 , Zhihui Zhang  1 , Zhaoli Yan  1
Affiliations
Meta-Analysis

Association Between Lipoprotein (A) and Diabetic Nephropathy in Patients With Type 2 Diabetes Mellitus: A Meta-Analysis

Xiaoyan Ren et al. Front Endocrinol (Lausanne). .

Abstract

Background: Lipoprotein (a) [Lp (a)] has been well recognized as a risk factor of cardiovascular disease. However, the association between serum Lp (a) and diabetic nephropathy in patients with type 2 diabetes mellitus (T2DM) remains unknown. We performed a meta-analysis to comprehensively evaluate the above association.

Methods: Observational studies aiming to evaluate the independent association between serum Lp (a) and diabetic nephropathy in T2DM patients were identified by systematic search of PubMed and Embase databases. A random-effect model which incorporated the potential intra-study heterogeneity was used for the meta-analysis.

Results: Eleven observational studies with 9304 T2DM patients were included. Results showed that compared to those with the lowest Lp (a), patients with the highest Lp (a) level had higher odds of diabetic nephropathy (adjusted odds ratio [OR]: 1.63, 95% confidence interval [CI]: 1.25-2.14, I2 = 54%, P < 0.001). Meta-analysis of studies in which Lp (a) was presented as continuous variables showed consistent result (adjusted OR: 1.13 for 1 mg/dl increment of Lp (a), 95% CI: 1.03-1.24, I2 = 36%, P = 0.008). Subgroup analyses showed that study characteristics such as definitions of diabetic nephropathy and study design did not significantly affect the association (P for subgroup difference all > 0.05).

Conclusions: Higher serum Lp (a) in patients with T2DM is independently associated with higher odds of diabetic nephropathy. Large scale prospective cohort studies are needed to validate this finding. Moreover, the potential influence of Lp (a) lowering on renal function in T2DM patients may be further investigated.

Keywords: diabetic nephropathy; lipoprotein (a); meta-analysis; observational studies; type 2 diabetes mellitus.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of database search and study identification.
Figure 2
Figure 2
Forest plots for the meta-analysis of the association between Lp (a) analyzed as categorized variables and diabetic nephropathy in T2DM patients; (A) results of main meta-analysis; and (B) results of subgroup analyses according to definition of diabetic nephropathy.
Figure 3
Figure 3
Subgroup analyses for the association between Lp (a) analyzed as categorized variables and diabetic nephropathy in T2DM patients. (A) Subgroup analyses according to the study design and (B) subgroup analyses according to the study country.
Figure 4
Figure 4
Forest plots for the meta-analysis of the association between Lp (a) analyzed as continuous variables and diabetic nephropathy in T2DM patients. (A) Results of main meta-analysis and (B) results of subgroup analyses according to definition of diabetic nephropathy.
Figure 5
Figure 5
Subgroup analyses for the association between Lp (a) analyzed as continuous variables and diabetic nephropathy in T2DM patients. (A) Subgroup analyses according to the study design and (B) subgroup analyses according to the study country.
Figure 6
Figure 6
Funnel plots for the publication bias underlying the meta-analysis of the association between Lp (a) and diabetic nephropathy in T2DM patients. (A) Forest plots for the meta-analysis of studies with Lp (a) analyzed as categorized variables and (B) forest plots for the meta-analysis of studies with Lp (a) analyzed as continuous variables.
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