A study of lipid profile in chronic kidney disease in pre- dialysis patients
Abstract
Introduction: Longitudinal studies have established that Cardiovascular Disease (CVD) occur more frequently and are the leading cause of death in Chronic Kidney Disease (CKD). Dyslipidemia has been established as an important risk factor in the pathogenesis of CVD in CKD patients.
Objectives: Present study was aimed to evaluate (in CKD patients),Demography along with Prevalence and Pattern of Dyslipidemiaand co-relation of Dyslipidemia with various CK Dstages. Methods: Present Cross-sectional study, conducted in Department of Medicine, R.D. Gardi Medical College and CRG hospital, Ujjain, M.P. from 1st January 2015 to 31st July 2016.We studied 115 pre-dialysis CKDcases and 100 age & sex matched controls. CKD was diagnosed as per 2012 KDOQI Criteria.
Result:In CKD cases,maximum 23.47% cases belonged to fifth decade. Mean age was 48.99 ± 16.74. Male to Female ratio was1.21: 1. Prevalence of individual dyslipidemias was High TC= 50.44%, High TG= 67%, High LDL-C= 42%, High VLDL-C= 67% and Low HDL-C= 73.9%. Overall, prevalence of dyslipidemia was 82.6%. Significant increase in TG and VLDL-C and significant decrease in HDL-C was observed. TC and LDL-C were non- significantly increased.TC, TG, LDL-C and VLDL-C were in increasing trend with progression of CKD stages (3-5) and increased in Subgroup II (ESRD) as compared to Subgroup I (Non-ESRD), the increase being significant in case of TG and VLDL-C. HDL-C value was in decreasing trend with progression of CKD stages and significantly decreased in Subgroup II as compared to Subgroup I.TC, TG, LDL-C and VLDL-C showed negative correlation with GFR while HDL-C showed positive correlation. TG, HDL-C and VLDL-C showed highly significant correlation. HDL-C showed strongest correlation, followed by TG.
Conclusion: Patients with CKD are predisposed to accelerated atherosclerosis leading to increased CVD. This study confirms the presence of atherogenic lipid profile in CKD.
Downloads
References
Dan L. Longo, Dennis L. Kasper, J. Larry Jameson, Anthony S. Fauci, Stephen L. Hauser,Joseph Loscalzo. Harrisons Principles of Internal Medicine, 18th Edition, New Delhi, McGraw- Hill, 2012. Vol-2, Page- 2308.
Liu M, Li XC, Lu L, et al. Cardiovascular disease and its relationship with chronic kidney disease. Eur Rev Med Pharmacol Sci. 2014 Oct;18(19):2918-26.
U.S. Renal Data System (USRDS), “Chronic kidney disease in the adult NHANES population,” USRDS Annual Report Data, 2009. (https://www.usrds.org/2009/view/v1_01_Abult_NHANES.asp)
Johnson DW, Craven AM, Isbel NM. Modification of cardiovascular risk in hemodialysis patients: an evidence-based review. Hemodial Int. 2007 Jan;11(1):1-14. DOI: https://doi.org/10.1111/j.1542-4758.2007.00146.x.
Harnett JD, Foley RN, Kent GM, et al. Congestive heart failure in dialysis patients: prevalence, incidence, prognosis and risk factors. Kidney Int. 1995 Mar;47(3):884-90.
Lewington S, Whitlock G, Clarke R, Sherlinker P, Emberson J, Halsey J,et al. Blood cholesterol and vascular mortality by age, sex and blood pressure a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet 2007; 370: 1829-39.
Vishwam Pandya, Akhilesh Rao, Kunal Chaudhary. Lipid abnormalities in kidney disease and management Strategies. World J Nephrol2015 February 6; 4(1): 83-91ISSN 2220-6124.
D.S.S.K. Raju, D.L. Lalitha and P. Kiranmayi. A Study of Lipid Profile and Lipid Peroxidation in Chronic Kidney Disease with Special Reference to Hemodialysis. J Clinic Res Bioeth2013, 4:143. DOI: https://doi.org/10.4172/2155-9627.1000143.
Kimak E, Solski J, Janicka L, Ksazeik A, Janicki K. Concentration of Lp(a) and other apolipoproteins in predialysis, haemodialysis, chronic ambulatory peritoneal dialysis and post- transplant patients. ClinChem Lab Med 2000; 38(5): 421-5.DOI: https://doi.org/10.1515/CCLM.2000.061.
Cheung AK, Parker CJ, Ren K, Iverius PH. Increased lipase inhibition inuremia: Identification of pre-beta HDL as a major inhibitor in normal and uremic plasma. Kidney Int 1996; 49 (5): 1360-7.
Oluseyi A. Adejumo, Enajite I. Okaka and Louis I. Ojogwu. Lipid profile in pre-dialysis chronic kidney disease patients in southern Nigeria. http://www.ghanamedj.org, Volume 50 Number 1 March 2016.
. Aharwar S, Lahariya D. A study of lipid profile in chronic kidney disease in non-diabetic patients. Journal of Evolution of Research in General Medicine 2015; Vol. 1, Issue 1, July-December 2015; Page: 16-20.
Avasthi G, Malhotra M, Narang A, Sengupta S. Study of thyroid function test in patients of chronic renal failure. Indian J Nephrol. 2001; 11:165-9.
Jungers P1, Chauveau P, Descamps-Latscha B, Labrunie M, Giraud E, Man NK, Grünfeld JP, Jacobs C. Age and gender-related incidence of chronic renal failure in a French urban area: a prospective epidemiologic study. Nephrol Dial Transplant. 1996 Aug;11(8):1542-6.
Gourav Garg, Sumit Pal Singh Chawla and Sarabjot Kaur. A clinical study of dyslipidemia in patients of chronic kidney disease.International Journal Of Bioassays, January 23, 2015,4 (03), 3732-3737.
Shah BV, Nair S, Sirsat RA. Outcome of end stage renal disease. J of Nephrol New Series 1992; 2:151-153
Koch A, Shan B, Nair S, Sirsat R, Ashavoid T, Nair K. Dyslipidemia in patients with chronic renal failure and in renal transplant.Journal of Postgraduate Medicine 1994; Vol 40: Issue 2, Page57-60.
Crook ED, Thallapureddy A, Migdal S, et al. Lipid abnormalities and renal disease: is dyslipidemia a predictor of progression of renal disease? Am J Med Sci. 2003 Jun;325(6):340-8.
Mannangi N, Jayasree S. Lipoprotein(a) & Lipid profile in Chronic kidney disease. Case control study. Webmed Central BIOCHEMISTRY2014;5(2):WMC004568. Doi: https://doi.org/10.9754/journal.wmc.2014.004568.
Rajesh Bhagwat, S. P. Joshi, PradeepSalgia, and AchalSepaha.Lipid abnormalities in chronic renal failure. Indian J ClinBiochem.1997 Dec; 12(1): 81–85.
A M Rao, A R Bitla, E P Reddy, V Sivakumar* and P V L N Srinivasa Rao. Lipid Abnormalities, Lipoprotein (A) And Apoprotein Pattern in Non-Dialyzed Patients with Chronic Kidney Disease. Indian Journal of Clinical Biochemistry, 2010 / 25 (1) 47-50.doi: https://doi.org/10.1007/s12291-010-0010-5
Sabeela Noor, Nudrat Anwar Zuberi, Fasiha Fatima, TahseenIqbal, Khalilullah. Status of Lipid Profile in Different Stages of Chronic Kidney Disease. Annals of Abbasi Shaheed Hospital & Karachi Medical & Dental College. 2014; 19(2);62-66.