STUDY OF SEVERITY AND PATTERN OF DYSLIPEDEMIA IN CHRONIC KIDNEY DISEASE

Amit Shah, Mrugal Doshi, Jaydutt Patel, Hetal Pandya

Abstract


Introduction

Coronary artery disease is a major cause of morbidity and mortality in patients with Chronic Kidney Disease (CKD). Dyslipidemia is an established coronary artery disease in the general population.  Patients with CKD exhibit significant alterations in lipoprotein metabolism, which in their most advanced form may result in the development of severe dyslipidemia which can lead to increased risk of cardiovascular complications. However, this relationship is less clear, and many studies show that low, rather than high, cholesterol levels predict mortality in this patient population. The aim of this study was to determine the prevalence and pattern of dyslipidemia in patients of CKD.

Method

This study was carried out in Dhiraj Hospital affiliated with SBKS MIRC after IEC approval, 50 patients of CKD according to KDOQI guidelines were enrolled after obtained written informed consent. Patients who were already diagnosed as having CAD, receiving haemodialysis, were on statin therapy were excluded from study. Detailed history and clinical examination done in all patients. Fasting lipid profile was done in all participants. Abnormality in any one of lipid components (Cholesterol, Triglyceride, HDL-C, LDL-C, VLDL) considered as dyslipidemia.

 Result

Out of 50 patients of CKD , 27(54%) patients were having dyslipidemia according to NCEP-ATP III guidelines. No correlation were found between in age, gender, BMI, HTN, DM and addiction with occurance of dyslipidemia in CKD patients (P-value=<0.05). Mean values of all lipid components  were in normal range except for VLDL. Most common lipid abnormality found was increased VLDL (30%) followed by hypertriglyceridemia (24%), decreased HDL-C in (18%), increased LDL-C in (10%). Hypercholesterolemia was detected in only 8% of patients. Mixed dyslipidemia was also noted. Hypertriglyceridemia + Increase VLDL was most common (25.9%) among them. Mean CR/CL was 10.18±5.95 for study population. Stage 5 CKD patients are having slightly more prevalence of dyslipidemia (57.5%) than stage 4 CKD (40%).

Conclusion

Higher prevalence of cardiovascular complications are found in CKD patients due to accelerated atherosclerosis leading to high risk of mortality. Dyslipidemia is one of the common risk factor for atherosclerotic changes in patients of CKD. This study confirms the high prevalence for of atherogenic lipid profile in patients of CKD which can lead to increased morbidity and mortality due to additional cardiovascular risks.


Keywords


Chronic Kidney Disease, Dyslipidemia.

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References


The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI), 2003.

George L. Bakris and Eberhard Ritz, Hypertension and Kidney Disease, A Marriage that Should Be Prevented, Kidney International 75, 449-452 (13 February 2009).

Gupta R, Trends in hypertension epidemiology in India, J Hum Hypertens, 2004, 18(2), 73–8.

Gourav Garg, Sumit Pal Singh Chawla and Sarabjot Kaur ,a clinical study of dyslipidemia in patients of chronic kidney disease, Int. J. Bioassays, 2015, 4 (03), 3732-3737

D.S.S.K.Raju1, D.L.Lalitha1 and P. Kiranmayi,A Study of Lipid Profile and Lipid Peroxidation in Chronic Kidney Disease with Special Reference to Hemodialysis , J Clinic Res Bioeth, Volume 4 • Issue 1 • 1000143J

Hetal Pandya, JD Lakhani, J Dadhania, A Trivedi ,The Prevalence and Pattern of Dyslipidemia among Type 2 Diabetic Patients at Rural Based Hospital in Gujarat, India. Indian Journal of Clinical Practice, Vol. 22, No. 12, May 2012

Bhagwat R, Joshi SP, Salgia P, Lipid abnormality in chronic renal failure, Indian Journal of Clinical Biochemistry, 1997, 12(1), 81-5.

Bhansali AS, Kumbhalkar SD, Salkar HR, Dyslipidemia in patients of chronic renal failure on dialysis, J Assoc phy India, 2003, 51, 1272-4.

Massy ZA, Khoa TN, Lacour B, Dyslipidemia and progression of renal disease in chronic renal failure patients, Nephrol Dial Transplant, 1999, 14, 2392-7.

Fliser D, Pacini G, Engelleiter R, Insulin resistance and hyperinsulinemia in patients with incipient renal disease, Kidney Int, 1998, 53, 1343-7.

Moberly JB, Attman PO, Samuelsson O, Apolipoprotein C-III, hypertriglyceridemia and triglyceride-rich lipoproteins in uremia, Miner Electrolyte Metab, 1999, 25, 258-62.

Appel G, Lipid abnormalities in renal disease, Kidney Int, 1991, 39, 169–83.

Bagdade J, Casaretto A, Albers J, Effects of chronic uremia, hemodialysis and renal transplantation on plasma lipids and lipoproteins in man, J Clin lab med, 1976, 87(1), 37-47.

Attman PO, Alaupovic P, Tavella M, Abnormal lipid and apolipoprotein composition of major lipoprotein density classes in patients with chronic renal failure, Nephrol Dial Transplant, 1996, 11, 65-9.

Tsumura M, Kinouchi T, Ono S, Serum lipid metabolism abnormalities and changes in lipoprotein contents in patients with advanced-stage renal disease, CCA, 2001, 314, 27-37.

Ljutfi Z, Koco C, Todor G, Lipid profile and concentration of ApoA-1 and ApoB-100 in patients with end-stage renal disease treated by repeated hemodialysis, Sec Biol Med Sci, 2008, 29, 141-52.

Ikewaki K, Schaefer JR, Frischmann ME, Delayed in vivo catabolism of intermediate-density lipoprotein and Lowdensity lipoprotein in hemodialysis patients as potential cause of premature atherosclerosis, Arterioscler Thromb Vasc Biol, 2005, 25, 2615–22.

Coimbra TM, Janssen U, Grone HJ, et al. Early events leading to renal injury in obese Zucker (fatty) rats with type II diabetes. Kidney Int 2000; 57:167–182.

Tonelli M, Keech A, Shepherd J, et al. Effect of pravastatin in people with diabetes and chronic kidney disease. J Am Soc Nephrol 2005; 16:3748– 3754.

Morena M, Cristol JP, Dantoine T, Protective effects of highdensity lipoprotein against oxidative stress are impaired in hemodialysis patients, Nephrol Dial Transplant, 2000, 15, 389-95.

Vaziri ND, Liang K, Parks JS, Down-regulation of hepatic lecithin: cholesterol acyltransferase gene expression in chronic renal failure, Kidney Int, 2001, 59, 2192-6.


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