Janani, C (2021) Serum Osteoprotegerin - Can it predict Chronic Kidney Disease among Hypertensives? Masters thesis, Government Mohan Kumaramangalam Medical College, Salem.
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Abstract
INTRODUCTION: Hypertension has been one of the major factors responsible for decline in renal function in patients with diabetic and non diabetic kidney disease. On the other hand, in patients with chronic kidney disease, high blood pressure may develop at an early course of the disease and contribute to several adverse outcomes. Thus, hypertension can be a cause or a consequence of CKD. Chronic kidney disease is the global health burden with a high economic cost to health systems. Chronic Kidney Disease is defined as damage to renal tissue or eGFR less than 60 ml/min/1.73 m2 for minimum of 3 months duration. Mild renal insufficiency is therefore not sensitively detected by serum creatinine levels. Hence, the detection of renal dysfunction at the initial stages is highly essential. Numerous biomarkers are now being explored in diagnosis, grading and prognosis of renal disorders. Increased osteoprotegerin (OPG) levels are associated with markers of vascular dysfunction such as vascular stiffness, endothelial damage and coronary calcification. OPG is emerging as a risk factor for development of cardiovascular diseases. It is associated with emerging risk of cardiovascular and all-cause mortality. With this background, this study aims to evaluate the association between OPG and renal dysfunction in hypertensive patients. MATERIALS AND METHODS: A Case control study was conducted in GMKMCH, Salem during December 2018 to november 2019. Sample size was 100 patients divided into 50 controls - CKD patients with hypertension and 50 hypertension patients as cases. 5 ml venous blood was taken for analysis. Serum Osteoprotegerin was determined using ELISA method. Other investigations such as blood urea, sugar, serum creatinine, lipid profile were done in the same sample. STATISTICS AND RESULTS: Graph Pad Prism 8.2.1 was used in statistical analysis. p value of less than 0.05 was considerd as significant. Mean and Standard Deviation was used to express the continuously distributed data. The mean value of various biochemical parameters between controls and cases were compared using unpaired t test. Pearson Correlation analysis was used to demonstrate the correlation of serum OPG levels with serum creatinine, protein, albumin, calcium and eGFR. Linear regression analysis was performed to evaluate the predictive role of the osteoprotegerin in renal dysfunction among hypertensive patients. The diagnostic accuracy of serum osteoprotegerin levels between hypertensive patients and CKD patients was found using ROC curve. In our study, the increase in serum osteoprotegerin levels with decreasing kidney function, was found to be correlated negatively with eGFR and positively with serum creatinine. This is well evident from the scatter plot between eGFR and OPG in hypertensive patients. Linear regression analysis showed a significant inverse relationship between eGFR and OPG with p value < 0.0001, which suggests that OPG can be a predictor of renal dysfunction among hypertensive patients. Serum OPG levels were increased with impairment of renal function. ROC curve analysis between hypertensive patients and patients with CKD, showed an area under the curve of 0.9378 with 95% CI, with optimal cut-off value 2.143 ng/ml. It had 93% sensitivity and 80% specificity. Hence, OPG can be used as an early marker for decline in renal function in hypertensive patients. CONCLUSION: Our study suggest that OPG plays a significant role in CKD progression among hypertensive patients. So, the estimation of serum OPG level may aid in early diagnosis of kidney dysfunction and also in predicting the progression of disease.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 201823603 |
| Uncontrolled Keywords: | Hypertension, Chronic Kidney Disease (CKD), Osteoprotegerin (OPG). |
| Subjects: | MEDICAL > Biochemistry |
| Depositing User: | Subramani R |
| Date Deposited: | 02 Dec 2021 16:44 |
| Last Modified: | 08 Jan 2022 12:33 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/18724 |
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