IDS Director of Intensive Diabetes Management, Tavia Vital
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By Treating High Cholesterol Early, You Can Reduce Kidney Health Risks
As part of your overall health management plan, following the ABCs as an important part of your diabetes wellness plan remains a solid recommendation. Nowadays, we may swap out Time in Range in place of A1c. Most people are very aware of the ongoing mission to have overall well-managed glucose levels as an important factor for risk reduction over time. The B is for blood pressure and is as important as overall glucose management. Last, but absolutely not least, is Cholesterol management.
In a recent summary article, “Lipid Abnormality in Diabetic Kidney Disease and Potential Treatment Advancements,” published in the March 2025 issue of Frontiers in Endocrinology by Tu et al, the authors explain that there are at least two distinct pathways for diabetes related kidney disease. These types of Chronic Kidney Disease (CKD) are commonly referred to as Diabetic Kidney Disease, or DKD, in the article. According to the authors, treating DKD using precision medicine may help lower the long-term risk of the progression of DKD.
The summary provides a helpful overview of the two main pathways that DKD develops over time. The delicate arteries in the kidneys can be damaged over time from inflammation, from high blood pressure, high blood glucose levels, and from high amounts of lipid (fat) deposits on the insides of the renal arteries. Of note, elevated Triglycerides and low levels of HDL cholesterol are predictors of future DKD even at the time of diagnosis for people with Type 2 Diabetes.
How to Lower Cholesterol
The main treatments for elevated LDL cholesterol and Triglyceride levels include healthful eating and regular physical activity habits, not smoking (or at least reducing smoking), stress reduction and utilizing coping skills, getting adequate and good quality sleep, and medications. Increased regular physical activity increases HDL cholesterol levels.
What Medications Lower Cholesterol
The main medications for improving elevated Triglycerides and elevated LDL cholesterol levels in early DKD include statin medications and fibrates. Statins and fibrates help reduce protein leaking from the kidneys into the urine and help slow down the decline in the kidneys’ filtration rates. Additionally, PCSK9 inhibitors show minimal side effects to the kidneys and help reduce inflammation in the kidneys and reduce albuminuria (protein leaking into the urine) better than statins or fibrates.
For people who do not tolerate the main cholesterol-reducing medications, or for people with severely elevated cholesterol levels, the article lists “In addition, LDL apheresis (LDL-A) and double filtration plasmapheresis (DFPP) are promising clinical applications in diabetic patients.”
Early intervention (medication) treatment for lipid (cholesterol) management can reduce the amount of damage done to the kidneys and may prevent DKD.
In addition, it is recommended to include kidney-helper and kidney-friendly medications for blood pressure and blood glucose management as indicated by the guidelines published annually by the American Diabetes Association and the American Heart Association to help further reduce kidney health-related risks.
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