ABSTRACT:

Background: Dyslipidemia in chronic renal insufficiency is one of the factors contributing to atherosclerosis and cardiovascular abnormalities. Changes in lipid status and their relation to severity of the disease is an active area of research, both in predialysis chronic kidney disease (CKD) patients and in patients on maintenance hemodialysis (HD).

Aim and objectives: we have undertaken this study with a view of analyzing the abnormal lipid profile pattern including Lipoprotein(a) or Lp(a), total cholesterol, triglycerides, Low Density Lipoprotein(LDL) and High Density Lipoprotein(HDL), in all stages of predialysis CKD patients and their correlation with GFR. we have also attempted to study the abnormal lipoprotein metabolism in patients on maintenance hemodialysis (CKD stage V).

Materials and methods: A total of 100 non diabetic subjects were further divided into 4 subgroups based on the GFR. Group1 comprising of healthy controls, group 2 of stage I and II CKD patients, group 3 of stage III and IV CKD patients and group 4 of stage V CKD patients on hemodialysis. Fasting blood samples were collected and analyzed for Lp(a), total cholesterol, triglycerides and HDL levels. LDL,GFR and BMI were the calculated parameters. GFR was calculated using MDRD formula and LDL by Freidwald’s formula. Statistical analysis: Statistical analysis was performed using SPSS version 16. One-way analysis of variance (ANOVA) and Pearson’s Correlation co-efficient and Regression equation were done.

Results: There is an increase in serum Lp(a) levels in all stages of CKD patients but significant increase is seen in groups 3 and 4 patients compared to that of the control group 1 (P<0.01). There is a significant rise in serum triglyceride levels in group 3 patients from that of the controls (P<0.01). There is a decrease in total cholesterol levels in group 4 patients compared to the controls (P<0.01).On comparison of serum LDL levels of controls with the other 3 groups, there is a significant elevation in groups 3 and 4 patients (P<0.01). There is no significant change in the serum HDL levels among the 4 groups. A negative significant correlation has been observed between Lp(a) and GFR.

Conclusion: The abnormal lipoprotein pattern especially Lp(a) seen in chronic renal failure patients may start early and progress with the declining renal function. These dysregulated lipoproteins may contribute to atherosclerosis and cardiovascular disorders which is the leading cause of death in these patients.

Keywords: Chronic kidney disease, hemodialysis, Lipoprotein(a), dyslipidemia

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