JMEDS

Lipid Profiles in10.5005/jp-journals-10045-0080

Patients with Chronic Kidney Disease
Original article

To evaluate Lipid Profiles in Patients with Chronic Kidney

Disease in RajaRajeswari Medical College and Hospital,
Bengaluru, Karnataka, India
1
Sharanappa Patil, 2V Ajith Kumar, 3Sandhya Subramani

ABSTRACT INTRODUCTION
Background and objectives: Dyslipidemia is a fairly common Chronic kidney disease (CKD) results when a disease
occurrence in chronic renal failure (CRF) patients. Cardiovascular process affects the structural or functional integrity of
mortality in patients with CRF is related to dyslipidemia. This
the kidneys. Chronic kidney failure is the result of CKD.
study was done to identify the lipid abnormalities and its signifi-
cance in CRF patients by comparing with age, sex, and body Chronic renal disease features various abnormalities
mass index (BMI) of matched healthy control population. of lipid metabolism, which results in an exceedingly
atherogenic profile. Although most striking lipid abnor-
Materials and methods: In this study, 56 cases of CRF were
taken and three fasting lipid profiles were estimated. Twenty- malities are seen in nephrotic syndrome, hyperlipidemia
five age-, sex-, and BMI-matched healthy population were characterizes renal disease of every cause.
taken as controls. The data were entered in a master sheet Lipid abnormalities in CRF are very important,
and analyzed statistically. because atherosclerotic heart disease is the foremost
Results: Dyslipidemia is seen in CRF patients. Even though cause of morbidity and mortality in patients with end-
the total cholesterol was high in CRF cases compared stage renal disease (ESRD).
with controls, the change was not significant statistically. Cardiovascular diseases are the leading causes of
Triglycerides showed a statistically significant increase in death in ESRD largely as the result of progressively
CRF cases. The low-density lipoprotein cholesterol (LDL-C)
increasing age of ESRD patients and the broad constel-
was elevated in CRF cases but the change was not significant
statistically. The high-density lipoprotein cholesterol (HDL-C),
lation of uremia-associated features. When the kidney
on the contrary, showed a statistically significant drop com- function has deteriorated and is no longer adequate to
pared with controls. sustain life, renal replacement therapy, dialysis, or trans-
plantation becomes necessary to maintain life. Hence, it
Interpretation and results: Lipid abnormalities are common in
CRF. Total cholesterol changes are not statistically significant. is important to prevent the development of chronic renal
Triglycerides shows statistically significant increase in CRF insufficiency and subsequent progression to ESRD.1-4
cases when compared with normal. The LDL-C is increased Unfortunately, kidney disease in its early stages is
in CRF patients, but it is not statistically significant when com- generally asymptomatic. Early identification of patients at
pared with controls. The HDL-C shows a statistically significant risk for CKD is essential. Major risk factors for the devel-
decrease in CRF patients compared with controls. These lipid
opment and progression of CKD include type I diabetes,
abnormalities may be an important contributing factor to the
cardiovascular mortality in patients with CRF. high blood pressure, protein barrier, family history of
kidney disease, and increasing age.
Keywords: Chronic kidney disease, Dyslipidemia, Lipid profile.
The progression of kidney disease to end stage can be
How to cite this article: Patil S, Kumar VA, Subramani S. To slowed by glycemic control (in diabetes), blood pressure
evaluate Lipid Profiles in Patients with Chronic Kidney Disease control for the patients with high blood pressure and use
in RajaRajeswari Medical College and Hospital, Bengaluru,
of angiotensin-converting enzyme inhibitors.2-4
Karnataka, India. J Med Sci 2018;4(2):31-34.
Cardiovascular disease is the major cause of death
Source of support: Nil among patients with CRF and ESRD. In addition to
Conflict of interest: None impairing the microcirculation, hypertension may con-
tribute to the development of atherosclerotic coronary
artery disease particularly in the presence of many lipid
1
Senior Resident, 2Professor, 3Postgraduate Student abnormalities observed in ESRD.
1-3
Department of General Medicine, RajaRajeshwari Medical The patients have reduced HDL-C and increased
College & Hospital, Bengaluru, Karnataka, India plasma triglyceride concentrations and there is defect in
Corresponding Author: V Ajith Kumar, Professor, Department the cholesterol transport. Other factors that may contrib-
of General Medicine, RajaRajeshwari Medical College & ute to atherosclerotic coronary artery disease in ESRD
Hospital, Bengaluru, Karnataka, India, Phone: +919845243763 are reduced HDL-C synthesis and reduced activity of
e-mail: [email protected]
the reverse cholesterol pathway.
The Journal of Medical Sciences, April-June 2018;4(2):31-34 31
Sharanappa Patil et al

The spectrum of dyslipidemia in patients with CKD cholesterol in the supernatant was measured after precipi-
and dialysis patients is distinct from that of the general tation of apolipoprotein B (Apo-B) containing lipoprotein
population. It involves all lipoprotein classes and shows to determine the HDL-C. The LDL-C is estimated using
considerable variations depending on the stage of CKD.5-9 Friedewald formula.
Also, a growing amount of clinical experience data Friedewald formula appears to be the most practical
suggests that lipids may be important in the development and reliable method for determining LDL-C in clinical
and progression of chronic renal disease. Potentially practice.
injurious lipid abnormalities are invariably present in LDL-C = Total cholesterol-[HDL-C + (Triglycerides/5)]
these patients more likely to progress to ESRD.
So, the analysis of lipoprotein subclass in CRF patients Very-low-density lipoprotein (VLDL) is estimated
is very much essential to assess the clinical outcome. by dividing the plasma triglycerides by 5, reflecting the
ratio of cholesterol to triglyceride in VLDL particles. This
MATERIALS AND METHODS formula is reasonably accurate if the test resolution is
obtained on fasting plasma and if the triglyceride level
Source of Data is less than 350 mg/dL. The accurate determination of
Patients with CKD presenting to RajaRajeswari Medical LDL-C level in conditions with triglyceride levels greater
College & Hospital (RRMCH), Bengaluru. than this requires application of ultra centrifugation
techniques (Beta quantification).
Data Collection Consent: Informed consent was obtained.
Study subjects: The present study is a cross-sectional
Statistical Tools
study conducted on 50 patients who are diagnosed with
CKD and presenting to RRMCH during a period of 1 year. The data collected regarding all the selected cases were
recorded in a master chart. Data analysis was done with
Inclusion Criteria the help of computer using Epidemiological Information
Package (EPI 2002). Using this software, range, frequen-
• Patients with CKD
cies, percentages, means, standard deviations, chi- square,
• Between age group of 18 and 80 years
and p-values were calculated. Kruskal–Wallis chi-square
• With known CKD irrespective of the etiology
test was used to test the significance of difference between
• On conservative or dialysis treatment for CKD
quantitative variables. A p-value less than 0.05 was taken
• As evidenced radiologically (bilateral shrunken
to denote significant relationship.
kidney/loss of corticomedullary differentiation) or
biochemically (elevated blood urea, serum creatinine) RESULTS
for more than 3 months
The results are tabulated in Tables 1 to 4 and Graphs 1
Exclusion Criteria and 2.
• Patients with acute renal failure and nephrotic
Table 1: Age distribution
syndrome
Cases Control
• Patients on drugs affecting lipid metabolism like β Age group (years) No. % No. %
blockers, statins, steroids, and oral contraceptive pills 41–45 1 1.8 4 16
• Female patients who are pregnant 46–50 29 51.8 12 48
• Known hypothyroidism 51–55 19 33.9 5 20
These patients were evaluated based on the proforma 55–59 7 12.5 4 16
Total 56 100 25 100
on the following guidelines:
Range 45–57 41–59
• Clinical history and physical examination. Mean 51.2 50.4
• Routine investigations like blood hemoglobin (HB)%, Standard deviation 3.0 4.9
total count, differential count, blood sugar, and urine p-value 0.1536
analysis. Not significant
• Renal parameters including blood urea, serum
Table 2: Sex distribution
creatinine.
• Fasting lipid profile. Cases Controls
Sex No. % No. %
• Ultrasonogram abdomen.
Male 28 50 10 40
All specimens were analyzed within 4 to 6 hours Female 28 50 15 60
of collection. Total cholesterol and triglycerides in the p-value 0.7945
plasma were measured enzymatically and then the Not significant

32
 JMEDS

Lipid Profiles in Patients with Chronic Kidney Disease

Table 3: Body mass index Among 56 cases, the mean age was 51.2 years with the
BMI Cases Control cases range of 45–57 years. The mean age of controls was 50.4
Range 22–26 22–26 years and the range was 41–59 years. There was no signifi-
Mean 24.55 24.76 cant difference between cases and controls with regard
Standard deviation 1.08 1.09 to the age (p-value 0.1536). So, they can be compared.
p-value 0.3668 There were equal number of males and females in
Not significant the study group, 28 males and 28 females. Among the 25
controls, 10 were males and 15 were females. There was
no significant difference between cases and controls as
DISCUSSION far as sex is concerned (p-value 0.7945). The mean BMI
Chronic kidney disease results when a disease process of the cases was 24.55 kg/m2.
affects the structural or functional integrity of the The mean BMI of the controls was 24.76 kg/m2. There
kidneys. Chronic kidney failure is the result of CKD. was no significant difference between cases and controls
Cardiovascular disease is a major cause of mortality with respect to BMI.
in patients with mild-to-moderate CKD and ESRD. On analyzing the lipid profile and comparing the
Dyslipidemia has been established as a well-known tra- CRF cases with controls, we found that there is signifi-
ditional risk factor for cardiovascular disease in general cant increase in triglycerides and significant decrease
population and it is well known that patient with CKD in HDL-C. The change in total cholesterol and LDL-C
exhibits significant alterations in lipoprotein metabolism, between cases and controls was not significant.
which, in their most advanced form, may result in the
Total Cholesterol
development of severe dyslipidemia.
This study was done to identify the lipid abnormali- The mean total cholesterol in the CRF cases was 213.6 mg/
ties that occur in CRF patients admitted in RRMCH. A dL and that of the controls was 207.8 mg/dL. There was no
total of 56 cases who fulfilled the diagnostic criteria for statistically significant difference in this parameter (p-value
CRF were included in the study. Twenty-five age-, sex-, 0.1761). This observation was similar to the results obtained
and BMI-matched healthy controls who fulfilled the by Kimak et al in their work on plasma lipoproteins in CRF
inclusion and exclusion criteria were taken for compar- patients. They also concluded that total cholesterol is not
ing the lipid profile. increased significantly in patients with CRF.10

Table 4: Lipid profile

Cases Controls
Lipid Range Mean SD Range Mean SD p-value
TC 158–269 213.6 14.9 132–245 207.8 22.1 0.1761 NS
TGL 110–264 205.9 44.9 112–180 148.0 16.3 0.0001 S
HDL 16–75 39 18.5 38–86 60.7 14.3 0.0001 S
LDL 110–171 139.4 16.4 110–172 127.2 15.6 0.1031 NS
SD: Standard deviation; TC: Total cholesterol; TGL: Triglyceride; NS: Not significant; S: Significant

Graph 1: Age distribution Graph 2: Sex distribution

The Journal of Medical Sciences, April-June 2018;4(2):31-34 33

Sharanappa Patil et al

Triglycerides generally have reduced plasma HDL-C concentrations

when compared with nonuremic individuals.
Significant increase in serum triglycerides was seen in
cases when compared with controls. Mean triglycer-
CONCLUSION
ides was 205.9 mg in cases and 148 mg/dL in controls
(p-value 0.0001). This result is in concordance with the Lipid abnormalities are common in CRF. Total cholesterol
work done by Kimak et al, in which they demonstrated changes are not statistically significant. Triglycerides
significant increase in triglycerides, LDL, and Apo-B con- show statistically significant increase in CRF cases when
centrations.11 In another study done by Bhagwat et al,11 compared with normal. The LDL-C is increased in CRF
they concluded that CRF patients were having marked patients, but it is not statistically significant when com-
triglyceridemia of 232 mg/dL as compared with controls pared with controls. The HDL-C shows a statistically sig-
(p-value < 0.01). Another Indian study on dyslipidemia nificant decrease in CRF patients compared with controls.
in patients with CRF and renal transplantation by Shah
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