Details
Category: Volume 08 Issue 03 March 2020
Hits: 1329

Title: Study of Lipid Profile in Non Diabetic CKD Patients

Authors: Asso Prof. Dr Malati Murmu, Asst Prof. Dr Pravas Sahu, Asst Prof. Dr Manoranjan Naik, Dr Om Prakash Nayak, Dr Soumya Ranjan Patra

 DOI: https://dx.doi.org/10.18535/jmscr/v8i3.98

Abstract

   

Background: Chronic Kidney Disease (CKD) is a worldwide health problem and one of the major health burden in developing countries like India. Dyslipidemia due to alteration in lipoprotein metabolism was considered as a complication of end stage renal disease (ESRD) but these changes can be present in early stages of CKD. Over the last decade it is established that Cardio-Vascular Disease is the major cause of mortality with mild to moderate and ESRD. The present study focused on finding an approximate prevalence of dyslipidemia,type of alteration in lipid fractions in non diabetic CKD populations and the association with staging.

Methods: The study was conducted in VIMSAR, Burla during NOV 2017 to OCT 2019 with an objective to study the lipid profile in non diabetic CKD patients. Patients with CKD admitted to Dept. of Gen. Medicine And Nephrology who had given consent for the study were the source of data.  History, clinical examination with supporting biochemical and radiological evidences of 150 cases were taken for diagnosis of CKD. 75 numbers of age and sex matched healthy indivisuals were taken as control. MDRD equation was used to calculate eGFR. Staging of CKD is as per KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management Of Chronic Kidney Disease.

Results: Among a total of 150 patients with mean age of 52.92 ± 11.41, the prevalence of dyslipidemia in CKD was found to be about 78.67%. There is significant increase in serum TG with the increase in severity of the disease. Most common abnormality is fall in the serum HDL cholesterol in 59.33% of patients followed by a rise in serum triglyceride concentration 51.33% in patients suffering from CKD.

Conclusion: The high prevalence of lipid abnormalities in CKD may accelerate the progression of Cardio Vascular Disease and increase the mortality of patients. Hence it is worthwhile to early diagnose and manage accordingly to reduce morbidity and mortality.

References

  1. Wang H, Naghavi M, Allen C, et al. GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388:1459–544.
  2. Singh et al.: Epidemiology and risk factors of chronic kidney disease in India – results from the SEEK (Screening and Early Evaluation of Kidney Disease) study. BMC Nephrology 2013 14:114.
  3. Vaziri ND: Dyslipidemia of chronic renal Failure the nature, mechanism, and potential consequences. Am J Physiol Renal Physiol 2006; 290: F262-F272.
  4. Mohanraj, G.Anbazhagan, S. Kalaivalli. “Evaluation of Lipid Profile in Non – Diabetic Chronic Kidney Disease Stage 3 and 4”. Journal of Evidence Based Medicine and Healthcare; Volume 1, Issue 6, August 2014; Page:338-346.
  5. Ganta V et al. Int J Adv.Med 2016 Nov; 3(4) .965-970.
  6. Sarnak MJ, Levey AS Schoolwerth AC, Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association councils on Kidney in cardiovascular disease, High blood pressure research, Clinical cardiology and Epidemiology and Prevention. Circulation 2003;108:2154-2169.
  7. Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in Chronic Renal Disease. Kidney1998; 32: S112-S119.
  8. Study of lipid profile and oxidative stress in chronic renal failure. Sumathi M.E., Manjunath M Tembad, Jayaprakashmurthy D.S., Preethi B.P. Biomedical Research 2010;(4): 451-456.
  9. Kumari KR and Srinivas B. Study of Lipid Profile in Patients with Chronic Kidney Disease on Conservative Management and Hemodialysis. Int J Sci Stud 2018;6(7):108-113.
  10. Third Report of the National Cholesterol Education Program(NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III
  11. Rajapurkar et al. BMC Nephrology 2012, 13:10.
  12. Agarwal SK, Dash SC, IrsadM,Raju S, Pandey RM. Prevalence of chronic renal failure in adults in Delhi.Nephrol Dial Transplant. 2005;20:1638-42.
  13. Sathyan et al. Int Jof Community Med Public Health.2016Dec;3(12:3487-3492).
  14. Brunskill NJ. Albumin signals the coming of age of proteinuric nephropathy. J Am Soc Nephrol 2004;15: 504–505.
  15. Magil AB. Interstitial foam cells and oxidized lipoprotein in human glomerular disease. Mod Pathol 1999; 12: 33–40.
  16. Lee HS, Lee JS, Koh HI, and Ko KW. Intra glomerular lipid deposition in routine biopsies. Clin Nephrol,1991; 36: 67–75.
  17. Moorhead JF, Wheeler DC, and Varghese Z. Glomerular structures and lipids in progressive renal disease. Am J Med1989; 87: 12N–20N.
  18. Wheeler DC and Chana RS. Interactions between lipoproteins, glomerular cells and matrix. Miner Electrolyte Metab, 1993; 19: 149–164.
  19. Coritsidis G, Rifici V, Gupta S, Rie J, Shan ZH, Neugarten J, and Schlondorff D. Preferential binding of oxidized LDL to rat glomeruli in vivo and cultured mesangial cells in vitro. Kidney Int, 1991; 39: 858–866.
  20. Gupta S, Rifici V, Crowley S, Brownlee M, Shan Z, and Schlondorff. Interactions of LDL and modified LDL with mesangial cells and matrix. Kidney Int, 1992; 41: 1161–1169.
  21. Rovin BH and Tan LC. LDL stimulates mesangial fibronectin production and chemoattractant expression. Kidney Int, 1993;43: 218–225.
  22. Hunsicker LG, Adler S, Caggiula A, England BK, Greene T, Kusek JW, Rogers NL, and Teschan PE. Predictors of the progression of renal disease in the Modification of Diet in Renal Disease Study. Kidney Int , 1997;51: 1908–1919.
  23. Schaeffner ES, Kurth T, Curhan GC, Glynn RJ, Rexrode KM, Baigent C, Buring JE, and Gaziano JM. Cholesterol and the risk of renal dysfunction in apparently healthy men. J Am Soc Nephrol, 2003;14: 2084–2091.
  24. Kuivenhoven JA, Pritchard H, Hill J, Frohlich J, Assmann G, and Kastelein J. The molecular pathology of lecithin: cholesterol acyltransferase (LCAT) deficiency syndrome. J Lipid Res, 1997; 38: 191–205.
  25. Gupta DK. Hypedipidemia in patents of chronic renal failure.Bombay Hospital J 1991; 33:45 50.
  26. Das BS, Mishra SK, Rao DVP. Serum lipids in chronic renal failure. J Assoc Physicians India 1984; 32:1019 1021.
  27. Bagdade J, Casaretto A. Effect of chronic uremia, haemodialysis and renal transplantation on plasma lipids and lipoproteins. J Clin Invest1976;87:374.
  28. DIANA M.LEE et al:Lipoprotein particle abnormalities and the impaired lipolysis in renal insufficiency, kidney international, vol.61,2002,pp209-218.
  29. Rapport J, Aviram M. “Defective high density lipoprotein composition inpatients on chronic hemodialysis”. New Eng J Med, 1978;299: 1326-1329.
  30. Nisha I. Parikh, Shih-Jen Hwang , Marin G. Larson,Daniel Levy, Caroline S. Fox. Am J Cardiol:2008:102(1):47-53.
  31. Bowel B, Xie Y,Xian H, Balasubramanian S, Al-Aly Z:Low levels of hidh density lipoprotein cholesterol increase the risk of incident kidney disease and its progression.Kidney Int 89:886-896,2016.
  32. Shah BV., et al. “Dyslipidemia in patients with chronic renal failure and renal transplant patients”. J.Post-grad Med, 1994; 40(2): 52-54.
  33. Gerald Appel. “Lipid abnormalities in renal disease”. Kidney Int, 1991;39: 169-183.
  34. Anderson Sharon, Garcia, Diego L and Brenner B.M., “Renal and systemic manifestations and glomerular disease”. Chapter-38 Text book of Kidney, Vol.2, Edn.4, W.B. Saunders Company, Philadelphia, 1991:1852-1860pp.
  35. Liang K, Vaziri ND. Gene expression of LDL receptor, HMG-CoA reductase and cholesterol-7 alpha-hydroxylase in chronic renal failure. Nephrol Dial Transplant. 1997; 12: 1381–6
  36. Vaziri ND and Liang K. Downregulation of hepatic LDL receptor expression in experimental nephrosis. Kidney Int50: 887–893, 1996.

Corresponding Author

Dr Soumya Ranjan Patra