M C Chandru

Abstract

Background & Objective: With increasing prevalence of Chronic Kidney Disease (CKD), CKD related cardiovascular diseases (CVD), end stage renal disease (ESRD) and the consequent financial burden of renal replacement therapy (RRT), the importance of CKD and its risk factors needs to be considered. Hence, lipid profile was studied in maintenance hemodialysis (MHD) subjects. Materials and Methods: An observational study consisting 100 patients diagnosed as ESRD on MHD of age group 18-70 years of both sex were selected from Nephrology unit, KIMS, Hubballi. Serum lipid profile was estimated by enzymatic method, urea by GLDH- Urease method, serum creatinine by Jaffe’s method. Results: A significant patients had low serum lipid levels with mean + standard deviation of Total cholesterol (mg/dl) 131.9349.75, Triacylglyceride (mg/dl) 107.53+52.36, HDL-C (mg/dl) 28.93+10.06 & LDL-C (mg/dl) 82.2342.89 and serum creatinine (mg/dl) 8.28+ 2.45 & Blood urea (mg/dl) 110.51+ 37.58 Conclusion: ESRD patients are at higher risk and it is expected to have serum lipids as per NCEP-ATP-III guidelines. In contrast to this, where these levels are associated with increased risk of CVD, decrease values in dialysis patients are strongly correlated with increased morbidity including a higher risk of cardiovascular events and death. This observation is referred as “reverse epidemiology/risk factor–paradox”. It may be due to superimposed factors like inflammation and/or malnutrition that lead to lower cholesterol levels. In addition, chronic renal failure per se, primarily affects the metabolism of HDL-C and Triacylglyceride rich lipoproteins. Despite conflicting reports, hypercholesterolemia paradoxically appears to be associated with more favorable outcome in ESRD patients. Keywords: Cardiovascular disease, ERSD, Hypercholesterolemia, Inflammation, Maintenance hemodialysis, Malnutrition.

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Abstract

Introduction and Objective: Chronic inflammation & lipid peroxidation plays a pivotal role in the etiopathogenesis of cardiovascular risks in many clinical conditions. Whereas, Lichen planus (LP), is a chronic skin inflammatory disorder which disturbs lipid metabolism& increases the lipid peroxides. However, there are limited data about the correlation between oxidative stress & hypertriglyceridemia in LP, hence the study was undertaken to 1) Estimate the levels of TG (triglycerides) & MDA (malondialdehyde) levels & 2) to correlate between the MDA & TG levels in LP patients. Materials and Methods: A case control study was done at KIMS hospital, Hubli, which included 50 LP patients and 50 healthy individuals. Serum levels of TG (GPO-PAP method) and MDA (TBA method) was done. Result: Patients with LP presented higher significant TG values (182.93 vs. 113 mg? dl), MDA values (4.81 vs. 3.99 nmol/ml) vs. controls.Also,our study showed positive correlation between TAG & MDA levels which is statistically significant (0.012). Interpretation and Conclusion: Thus,the present study showed increased levels of TG & MDA, indicating that hypertriglyceridemia & lipid peroxidation may have domino effect with each other due to chronic inflammation & thereby may increase the cardiovascular complications in LP patients. Keywords: Atherosclerosis, Cardiovascular risks, Dyslipidemias, Chronic inflammation, Lichen planus, Oxidative stress.

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Abstract

Introduction: In recent years the burden of chronic kidney disease has increased worldwide. End Stage Renal Disease (ESRD) needs Hemodialysis as a common renal replacement therapy to reduce its morbidity and mortality. Hemodialysis adequacy must be maintained for effective treatment and is measured either by Urea Kinetic Model (Kt/V), Urea Reduction Ratio (URR), natural log Kt/V or Daugirdas 2nd generation formula. Though Kt/V is accurate, URR is commonly used in clinical practice because of its simplicity and clear concept. Objective: To estimate and compare URR with single pool Kt/V in assessing hemodialysis adequacy. Materials and Methods: An experimental prospective study consisting of 100 ESRD patients of either sex between 18-70 years, who were on hemodialysis maintenance. Blood urea was estimated by GLDH- urease method and serum creatinine by Jaffe’s method. Values were substituted in URR and Kt/V formula. Results and Conclusion: There was a significant difference in serum Urea levels after dialysis treatment (P< 0>positive correlation with Kt/V. Since the URR and Kt/V are closely related, their predictive power in terms of patient outcome is similar. However, use of Kt/V and urea modelling allows for comparing expected with predicted dialysis dose that can be used to analyse dialysis treatment and dialyzer clearance. Keywords: Urea reduction ratio, Kt/V, ESRD, Hemodialysis adequacy, Renal Dialysis, Urea

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