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Table of Content - Volume 4 Issue 2 - November 2017
Uric acid and lipid ratios in lean normoglycemic patients of chronic kidney disease
Cherekar L N1*, Hazari N R2
1Associate Professor, Department of Biochemistry, Government Medical College, Jalgaon, Maharashtra, INDIA. 2Associate Professor, Department of Biochemistry, Government Medical College, Aurangabad, Maharashtra, INDIA. Email: cherekarln@rediffmail.com
Abstract Objectives: To investigate the derangement of lipid ratios in normoglycemic lean chronic kidney disease patients. To find out the correlation of uric acid with the lipid ratios. Materials and Methods: 50 lean (BMI <25) normoglycemic patients with chronic kidney disease having calculated GFR <75 ml/min/1.73 m2 comprised the study group and 50 normal lean (BMI < 25) healthy age and sex matched subjects comprised the control group. Serum uric acid and lipid profile are measured by using commercially available kits on semi automatic analyser. Results: We found that TC/HDL, LDL/HDL and TG/HDL ratio are statistically significantly elevated in study group than in controls. The elevated serum uric acid was significantly positively correlated with TG/HDL ratio. Conclusion: Serum uric acid is significantly associated with TG/HDL ratio in lean and normoglycemic patients of chronic kidney disease. Key Words: Chronic kidney disease (CKD), Lipid ratios, Uric acid.
In recent decades increase in the prevalence of chronic kidney disease (CKD) is observed. Chronic kidney disease is a major risk factor for premature cardio vascular disease and mortality1. It is a global public health problem2. Serum Uric Acid (SUA): Recently it has been found that hyperuricemia associated with various dieases such as hypertension, atherosclerosis, cardiovascular disease and chronic kidney diseses.3. Serum uric acid has a role in insulin resistance and dyslipidemia,4. The suggested mechanism to cause chronic kidney disease due to hyperuricemia is vascular smooth muscle proliferation, endothelial dysfunction, impaired endothelial nitric oxide production.5,6,7 Various Studies show a significant association between hyperuricemia and chronic kidney disease. Some of the studies didn’t find any statistical significant change in uric acid with decline in renal function8. Lipid ratios: It is well known that lipid derangement is associated with atherosclerosis. Chronic kidney disease is known to be associated with atherosclerosis. Some study show that hypertriglyceridemia and low high density lipoprotein are risk factors for chronic kidney disease9,10. Few study we got didn’t find any association between hypertriglyceridemia and high density lipoprotein with chronic kidney disease.11,12. Triglyceride / high density lipoprotein (TG/HDL) has been identified as an indicator of insulin resistance and atherosclerosis.13 Low high density lipoprotein and high triglyceride concentration induce increase in small dense low density lipoproteins particles which increases atherogenicity of plasma14. Also total cholesterol/high density lipoprotein (TC/HDL) and low density lipoprotein/high density lipoprotein (LDL/HDL) are independent risk factors for coronary artery disease.15. With this background we intended to find the levels of lipid ratios and uric acid in chronic kidney disease also to find out the association of uric acid with different lipid ratios in these patients of chronic kidney disease.
MATERIALS AND METHODS Total 100 subjects in age group of 25 to 60 years were studied. Informed consent was taken from the subjects included in the study. Study was conducted as per guidelines of ethics committee. The subjects were divided in two groups, Group I – (n=50) healthy controls (BMI <25) (Cr.Cl.>75ml/min/1.73m2) not suffering from any major illness comprised control group. Group II – (n=50) non obese chronic kidney disease patients (BMI < 25) (Cr.Cl.<75ml/min/1.73m2) comprised cases group. In all these subjects BMI, fasting blood sugar, serum creatinine, lipid profile, lipid ratios, serum uric acid estimations were done. BMI calculated as Wt (Kg)/ height (m2). Blood Sugar, Serum creatinine, lipid profile, serum uric acid estimated by using commercially available kits. Creatinine clearance was calculated by Schwartz formula -0.55x height (cm)/ serum creatinine (mg/dl). Serum LDL cholesterol was calculated by Friedwalds formula. Total cholesterol/hdl (TC/HDL), TG/HDL, LDL/HDL and total cholesterol- HDL= non HDL cholesterol (non HDL), non HDL/HDL lipid ratios were calculated. Statistical Analysis: The collected Data was compiled in MS-Excel Sheet. Data was represented in the form of mean +S.D. The two groups were analysed by comparing parameters by applying unpaired t test. Pearson correlation coefficient was calculated. P value was checked at 0.05 level of significance. The study group was composed of 31 females and 69 males in the age group of 25 to 60 years. The mean serum uric acid values in chronic kidney disease patients, cases (group II) were significantly high as compared to mean serum uric acid values in control group I (p <0.01). (Table 1 and 2) The mean serum total cholesterol and LDL values were significantly higher in chronic kidney disease patients, cases (group II) as compared to mean serum total cholesterol and LDL values in control (group I) (p < 0.001). The mean serum HDL cholesterol values in cases (group II) were significantly lower as compared to mean serum HDL cholesterol values in control (group I). (p<0.001). But the mean serum TG values in cases (group II) were non significant when compared to mean serum TG values in controls (group I) (p=0.22) (Table 2). The mean serum total cholesterol(TC)/HDL, LDL/HDL, non HDL/HDL values were significantly higher in chronic kidney disease patients, cases (group II) as compared to mean serum total cholesterol (TC)/HDL, LDL/HDL, non HDL/HDL values in control (group I) (p < 0.001). The mean serum TG/HDL values in cases (group II) were significantly high as compared to mean serum TG/HDL values in control (group I) (p<0.01) (Table 3). High levels of serum uric acid were statistically significantly associated with serum TG/HDL ratio in the cases group (p<0.001). High levels of serum uric acid were statistically non significant when correlated with serum TC/HDL, LDL/HDL and non HDL/HDL ratio in the cases group (Table 3)
Table 1: Characteristics of the study population
Table 2: Clinical data with mean values of lipid profiles, lipid ratios, uric acid in both groups
Table 3: Correlation coefficient of uric acid and lipid ratios
DISCUSSION We found that increased serum uric acid was statistically significant in chronic kidney disease (CKD) patients, cases group II when compared to control group I (p < 0.01). Wang S et al (2011)16 suggested that hyperuricemia is a risk factor for chronic kidney disease (GFR< 60ml/min/1.73m2). Ling Li et al (2014)17 in the review and meta-analysis study found nearly thirteen studies shown significant positive association between elevated serum uric acid and new onset chronic kidney disease. Kyle E Rodenbach et al (2015)18 in their cohort study concluded that hyperuricemia is independent risk factor for faster progression of chronic kidney disease in children and adolescents. Vidyasagar Sarpal (2017)19 reported that higher serum uric acid associated with higher degrees of renal dysfunction, dyslipidemia and cardiovascular disease mortality. In present study higher levels of serum total cholesterol (TC), serum LDL were statistically significantly elevated in chronic kidney disease patients cases group II when compared to controls group I(p< 0.001). Lower levels of serum HDL were statistically significant in chronic kidney disease patients group II when compared to control group I (p<0.001). But serum TG levels were statistically non significant in chronic kidney disease patients group II when compared to control group I. Szu –Chia Chen et al (2013)20 demonstrated that in patients of CKD stage 3-5 showed dyslipidemia, either lower or higher total cholesterol, higher LDL-cholesterol, and higher non-HDL cholesterol were independently associated with rapid renal progression. Liying Zhang et al (2014)21 suggested that in men, only (log) TG was associated with CKD. In woman none of the serum lipids and lipid ratios was associated with CKD. In present study higher serum Total cholesterol (TC)/HDL, LDL/HDL, non HDL/HDL ratios were statistically significant in the chronic kidney disease patients (CKD) cases group II when compared to controls group I (p< 0.001). Higher TG/HDL ratio was statistically significant in chronic kidney disease patients cases group II when compared to controls group I (p < 0.01). Ji-Young Kim et al (2012)22 reported that the TG/HDL is the only lipid related ratio that is independently associated with CKD stage 3 or more in both sexes of Korean. Cabarkapa et al (2012)23 found that TG/HDL ratio is most suitable for evaluation of lipid disturbances in different stages of chronic renal failure. Yuji Shimizu et al (2014)24 suggested that high but not low TG-HDL diabetes constitutes significant risk for CKD. We found that higher levels of serum uric acid were statistically significant when correlated with TG/HDL ratio in chronic kidney disease (CKD) patients in cases (correlation coefficient 0.5218, p <0.001). Levels of uric acid were non significant when correlated with TC/HDL, LDL/HDL, non HDL/HDL (correlation coefficient 0.2527,0.1994 and 0.2457 respectively, p > 0.05). Alper Sonmez et al (2015)25 showed that elevated TG/HDL ratio predicts poor cardiovascular outcome in subjects with CKD. Onat A et al (2010)26 suggested TG/HDL ratio can be used as a surrogate of insulin resistace and can be used to predict coronary heart disease independently. The data in the present study showed that high serum uric acid adds additional cardiovascular risk information to the increased TG/HDL ratio in patients of chronic kidney disease. Serum uric acid and TG/HDL ratio both are cardiovascular risk factors in chronic kidney disease patients. We observed a statistically significant link in serum uric acid and TG/HDL ratio in chronic kidney disease patients. In summary cardiovascular disease risk is present in these patients of chronic kidney disease.
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