Lavanya, S (2008) A Study of Lipid Profile in Chronic Renal Failure Patients on Conservative Management, Hemodialysis and After Renal Transplantation. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Chronic renal failure (CRF) results in profound lipid disorders, which stem largely from dysregulation of high-density lipoprotein (HDL) and triglyceride-rich lipoprotein metabolism .Together, these abnormalities may contribute to the risk of arteriosclerotic cardiovascular disease and may adversely affect progression of renal disease and energy metabolism in CRF. Cardiovascular disease (CVD) is the leading cause of death among patients with chronic and end-stage renal disease (ESRD). There is growing evidence that cardiovascular damage begins as soon as the kidney loses function and increases in severity during the progression of kidney disease. Hypertension and diabetes mellitus, known risk factors for the development of CVD in the general population, are also the most common causes for the development of CVD in patients with CRF and ESRD. It is known that patients with type 2 diabetes who require dialysis are about 30 times more likely to die of CVD, including heart attacks and strokes, than the general population. There are several other important risk factors, such as smoking, proteinuria and dyslipidemia that independently or in combination with elevated blood pressure, can cause deterioration in renal function. Abnormalities in lipid metabolism and dyslipidemia are known to contribute to glomerulosclerosis and are common in renal disease. In addition, posttransplant dyslipidemias have been associated with an increased risk of ischemic heart disease and have been shown to increase risk of chronic rejection, altered graft function and mortality. However, only recently, trials are starting to evaluate if reversal of dyslipidemia can actually lead to a decreased risk of CVD in patients with chronic renal conditions. Various studies have been done to describe the characteristic features of lipoprotein metabolism during different stages of renal insufficiency and to describe the possible links between the underlying lipid transport abnormalities and the pathophysiology of lipoprotein abnormalities in patients with chronic renal failure. Similar abnormalities of lipid profile are found in chronic renal failure patients when they are on regular dialysis, but several other factors have been found to contribute to them. After renal transplantation, the addition of immunosuppressive treatment and the presence of renal rehabilitation causes other abnormalities of lipid transport. Since hyperlipidemias become more pronounced as renal failure advances and can be modulated by therapeutic intervention it is worthwhile to study and compare lipid profile abnormalities in renal failure patients on different modes of management. AIM OF THE STUDY: 1. To estimate the levels of Serum triglycerides, Serum total cholesterol, High density lipoprotein cholesterol, Low density lipoprotein cholesterol, Ratio of total cholesterol to HDL cholesterol level in patients of chronic renal failure; a. On conservative management, b. On regular hemodialysis, c. Following renal transplantation. 2. To compare the lipid profile of the above mentioned patients with that of healthy controls. MATERIALS AND METHOD OF STUDY: The study of lipid profile in patients of chronic renal failure was undertaken in The Department of Nephrology, Government Stanley Hospital, Chennai. SUBJECTS FOR THE STUDY: • The study group constituted patients of a) Chronic renal failure on conservative management b) Chronic renal failure on regular hemodialysis. c) Post Renal Transplantation with normal renal function. • The control group constituted twenty healthy adults – 10 males and 10 females of different age groups whose ages compared well with that of study group. SELECTION OF CASES: Study Group: a. Patients with chronic renal failure on conservative management for a period of at least 6 months comprising of 10 males and 10 females within the age group of 15-50 years with none of them having diabetes were taken up. b. Patients presenting with end stage renal failure on maintenance hemodialysis for period of 3 months comprising of 11 males and 9 females, all falling within the age group of 15 years to 50 years were taken up and none of them had Diabetes. c. Post transplant patients with normal renal functions comprising of 10 males and 10 females within the age group of 15- 50 years and none of them had Diabetes. Control Group: This group consisted of 10 males and 10 females whose age group compared well with that of the study group. It was ascertained that none of them had hypertension, diabetes mellitus, renal or liver disease or any other metabolic disorder. METHOD OF STUDY: Estimation of lipid profile The various parameters analysed were : • Serum total cholesterol (TC). • Serum high density lipoprotein cholesterol (HDL). • Serum low density lipoprotein cholesterol (LDL). • Serum triglycerides (TG). • Ratio of serum total cholesterol to high density lipoprotein. cholesterol (TC/HDL). Samples were collected after a 12 hour fast to avoid post prandial rise in serum triglyceride level. Analysis of total cholesterol, triglycerides and HDL was done by use of an autoanalyser. Serum LDL cholesterol was calculated by Frederickson Friedwald’s formula according to which LDL=total cholesterol – (HDL+VLDL). VLDL was calculated as 1/5th of triglycerides. The results were statistically analysed. CONCLUSION: There is no significant difference in the lipid profile between males and females in the different groups. On comparison with the control group • The mean total cholesterol is significantly increased in chronic renal failure patients after transplantation (p<0.001). • The mean triglyceride level is significantly increased in CRF patients on conservative management (p=0.029), on hemodialysis (p=0.045) and after transplantation (p=0.004). • The mean LDL cholesterol is significantly increased after transplantation (p=0.001). • The mean HDL cholesterol is significantly decreased in the conservative management group (p=0.001), the hemodialysis group (p<0.001) and in the post transplant group(p<0.001). • The total cholesterol to HDL cholesterol ratio is significantly increased in CRF patients on conservative management (p=0.002), on hemodialysis (p=0.0007) and after transplantation (p<0.001). • Due to increased prevalence of hyperlipidemia and its complications in chronic renal failure patients, early diagnosis of dyslipidemias is indicated and potential therapeutic approaches (therapeutic life style changes and pharmacotherapy) should be initiated to limit the long term consequences of cardiovascular disease in this population of patients, whose longevity is anticipated to increase with dialysis and transplantation.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Lipid Profile ; Chronic Renal Failure Patients ; Conservative Management ; Hemodialysis ; After Renal Transplantation |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 23 Mar 2018 16:01 |
| Last Modified: | 23 Mar 2018 16:01 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6476 |
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