Profile of Dyslipidemia In Chronic Kidney Disease: A Retrospective Study

Abstract

Background and Objectives: Chronic Kidney Disease (CKD) is increasingly becoming a major health problem all over the world and is also a major health problem in India. CKD has a high rate of cardiovascular morbidity and mortality. Studies have shown that approximately 50% of ESRD patients die from a cardiovascular cause. Recognized risk factors for cardiovascular disorder and known complications associated with CKD include anemia, hyperphosphatemia, hyperparathyroidism, fluid and electrolyte abnormalities and altered lipid metabolism. Amongst all the risk factors, dyslipidemia is a common complication of progressive kidney disease and contributes to the high cardiovascular morbidity and mortality of CKD patients. Anemia is an independent predictor of death in patients with CKD, and Anemia of CKD increases morbidity and mortality from cardiovascular complications which may lead to further deterioration of renal function and the establishment of a vicious cycle termed the “cardio-renal anemia syndrome”. CKD is also associated with adverse changes in bone-mineral metabolism. CKD-associated mineral bone disorders significantly increase mortality in CKD patients. Globally, many studies have been reported with respect to dyslipidemia, anaemia and/or bone-mineral disorder in renal diseases. However, very few reports are available with Indian population and none from western India. In light of this, the present study aims to investigate profile of dyslipidemia, anaemia markers and bone-disease parameters in CKD patients from western part of India. Study Methodology: This retrospective study included CKD patients registered at Institute of Kidney Disease and Research Centre, Ahmedabad. From the available records, patients were selected based on the inclusion and exclusion criteria. Medical records for 170 CKD patients were obtained from their respective case files. The study was purely retrospective and as such only analysis of available data was carried out. The study did not involve any interaction with the subjects, nor did it require any intervention in the management of patients. Similar medical records of 70 healthy kidney donors were also reviewed to compare the study population with this control group. Results: Demographics In the present study, there were total 23 males and 47 females in control group and 131 males and 39 females in study group. Out of 170 CKD patients 88(52%) of the patients were educated up to primary levels and 88(52%) patients had monthly income below Rs. 20,000. The domicile data showed that133 (78.24%) patients were from Gujarat, 20(11.76%) were from Rajasthan and remaining from other states like Madhya Pradesh, Uttar Pradesh, West Bengal, Bihar, Haryana and Maharashtra. Out of 170 CKD patients 126(74.1%) were Hindu, 26(15.3%) were Muslim, 5(3%) were Jain and Christian. Hypertension and diabetes were the leading causes of ESRD covering about 49% of patients. Other causes were chronic glomerulonephritis, obstructive uropathy, obstructive nephropathy, Alport’s syndrome, Amyloidosis and IgA nephropathy. Lipid Profile Present study indicated that the general profile of dyslipidemia among the study subjects was characterized by elevated triglycerides, VLDL and lower HDL cholesterols. The mean triglyceride and VLDL levels of the study group was significantly (p<0.01) higher as compared to the control group. Study group also exhibited significantly (p<0.01) reduced HDL level as compared to the control group. However, TC and LDL level were not significantly different in study group in comparison with the control group. Anemia Parameters Study group exhibited significantly (p<0.01) lower level of Hemoglobin compared to the control group. Ferritin levels in the study group were elevated significantly compared to the control group (p<0.01).Bone- Disease Parameters Serum Phosphate levels in study group were significantly higher (p<0.01) as compared to the control group, whereas serum calcium levels were significantly lower (p<0.01) compared to the control group. Patients in the study group also exhibited elevated PTH levels with about 82% of patients showing PTH levels more than normal range. Conclusions: In conclusion our study suggests that CKD patients suffered from dyslipidemia as depicted by increase in triglyceride, VLDL Levels and decrease in HDL levels. However, the total cholesterol and LDL levels were not significantly altered in CKD patients. The CKD patients also exhibited anemia which was characterized by reduction in hemoglobin levels and increased ferritin levels. CKD patients also suffered from hypocalcaemia and hyperphosphatemia. Thus, our data suggest that CKD patients from Western India have ‘cardio-renal anemia syndrome’ and lipid abnormalities which predispose the patients to atherosclerosis and hence are at higher risk of cardiovascular diseases.