The Uremic Dyslipidemia: A Cross-Sectional and Longitudinal Study

Avram, Morrell M.; Goldwasser, Philip; Burrell, Donna E.; Antignani, A; Fein, Paul A.; Mittman, Neal

doi:10.1016/s0272-6386(12)70294-9

Cited by 98 publications

(54 citation statements)

References 58 publications

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“…This is in concordance with the study conducted by Kaysen et al 15 TC levels also increased as the stage of CKD progressed, similar to findings of Kasiske BL et al study. 16 LDLc levels increased as the stage of CKD progressed except for stage 3 where it was higher than stage 4 and stage 5, but this was not statistically significant (p=O.15) and is in concordance with the study by Kasiske et al 16 Increased TC/HDLc ratio indicative of atherogenic risk in ESRD patients was found to be high and increased as the stage of disease progressed and was statistically significant(p=0035) concordant with studies of Cheung et al and Avram et al 17,18 The mean value of LDLc/HDLc was also high which is concordant to the studies of Cheung et al and Massy et al 17.19 This ratio increased as the stage of disease progressed except for stage 3 where it was higher than stage 4 and stage 5, and this was not statistically significant.…”

Section: Discussionsupporting

confidence: 88%

Study of thyroid dysfunction and dyslipidemia in chronic kidney diseases

Tripathy

Dhal

Kanungo³

et al. 2017

Int J Res Med Sci

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Background: Though there are many studies on thyroid dysfunction and dyslipidemia in Chronic Kidney Disease (CKD), no study is conclusive. Aim of this study was to correlate abnormalities in thyroid function and lipid profile with the severity of renal failure and also to observe the difference of these abnormalities between patients on conservative management verses hemodialysis. Methods: Hundred consecutive CKD cases admitted to Medicine Department were taken up for the study. They were divided into two groups as Group-A [on conservative management] and Group-B [on regular Hemodialysis (HD)]. Hundred healthy persons were taken as control in Group-C. After evaluation of thyroid function and lipid profile statistical analysis was done by students t-test, chi-square and regression analysis. Results: Hundred CKD cases with 74% male (n=74) and 26% female (n=26) in a M: F ratio of 2.9:1 were found to be in different stages CKD (0, 2, 20, 28 and 50 in stage-1 to stage-5 respectively). In 50 cases of stage-5 CKD, 30 were on HD and 20 on conservative management. Diabetes Mellitus (DM) (40%) was the commonest etiology of CKD followed by Hypertension (HTN), obstructive uropathy, chronic glomerulonephritis (CGN) and polycystic kidney disease (PKD). Thyromegaly was not found in a single case. In all CKD cases (Group-A+B) TT3 (TT3) was significantly low (P =0.0011) when compared with control (Group-C) and no difference was found between Group-A and Group-B. Fall in TT3 worsened with increasing severity of CKD. Lipid profile study revealed Decreased HighDensity Lipoprotein Cholesterol (HDLc) and increased Triglyceride (TG), Total Cholesterol (TC), Low Density Lipoprotein Cholesterol (LDLc), TC/HDLc and LDLc/HDLc in Group-A than Group-B but only TG and TC increase was statistically significant. The levels of TG and TC and TC/HDLc increased as the stage of CKD progressed and was statistically significant (P= 0.035). Conclusions: There occurs a state of biochemical hypothyroidism without overt clinical hypothyroid state in CKD, the extent of which correlates with the severity of CKD. Increased cardiovascular complications occur due to accelerated atherosclerosis in CKD. This study confirmed that atherogenic lipid profile and thyroid dysfunction worsen with the progression of disease. Difference between patients on conservative management and HD was not found.

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Section: Discussionsupporting

confidence: 88%

Study of thyroid dysfunction and dyslipidemia in chronic kidney diseases

Tripathy

Dhal

Kanungo³

et al. 2017

Int J Res Med Sci

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“…We did not have data, however, on HDL cholesterol or Lp(a). HDL cholesterol is protective against atherosclerosis and tends to be higher in blacks than in whites, both in the general population and in people with ESRD (27). Thus, HDL cholesterol may have contributed to the lower risk seen in blacks.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Atherosclerosis by Race in the Dialysis Morbidity and Mortality Study

Parekh¹,

Zhang²,

Fivush³

et al. 2005

Journal of the American Society of Nephrology

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White individuals who are on dialysis experience much higher overall and cardiovascular mortality rates than black individuals despite a more favorable risk factor profile, but the incidence of nonfatal cardiovascular disease (CVD) to this racial disparity has not been well studied. A longitudinal study of 16,103 people who had ESRD and were enrolled in the United Renal Data System from 1993 to 1996 was conducted. The incidence of new and recurrent atherosclerotic CVD (ASCVD) events was determined using Medicare claims for hospitalizations and mortality among blacks and whites, stratified by ASCVD at baseline. ASCVD was defined as coronary heart disease, peripheral vascular disease, and cerebrovascular disease. B lack individuals have higher total mortality than white individuals (1). Reasons for this disparity are unclear but may relate to underlying disparities in access to health care, income, education, diet, lifestyle, and increased prevalence of comorbid conditions (2-4). In contrast to the pattern seen in the general population, however, blacks who are on dialysis have a much lower overall mortality (179 per 1000 person-years) than whites (279 per 1000 person-years) (5). Understanding why blacks who are on dialysis have a lower death rate than whites who are on dialysis may yield insights into how to reduce the excess risk in blacks seen in the general population (6 -12).Cardiovascular disease (CVD) mortality is the leading cause of death in people who are treated with dialysis, at least 10-fold higher than in the general population (13), and may explain some of the paradoxic association of race with mortality in ESRD patients. Although CVD mortality has been reported to be 20% lower in black than in white ESRD patients (12,14), death from nonatherosclerotic forms of heart disease, such as cardiomyopathy and arrhythmias, was included in the definition of CVD. Furthermore, 40% of ESRD patients have CVD at the initiation of dialysis (15), and the risk for recurrent atherosclerotic CVD (ASCVD) events is likely to be much higher in people with prevalent disease. Thus, small differences in the prevalence of ASCVD may explain the observed differences in whites compared with blacks. Previous studies (15-17) that have adjusted for previous CVD have used data from the Center for Medicaid and Medicare Medical Evidence report, which have been shown to underreport preexisting conditions, especially CVD and smoking (18). Also, it is important to know whether the incidence of new ASCVD events differs by race to understand better ASCVD in the dialysis population. The aim of our study was to determine whether the incidence of new and recurrent ASCVD differs in whites and blacks in the US dialysis population using detailed patient information to characterize both prevalent ASCVD and CVD risk factors. Materials and Methods Study DesignWe performed a longitudinal cohort study of US incident and prevalent ESRD patients and determined the incidence of ASCVD events in a 3-yr period. Patients were excluded from the study when t...

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“…Approximately 20 to 40% of hemodialysis patients have been estimated to have elevated triglycerides and reduced HDL-C (29,30) (Figure 1). In addition, increased oxidized LDL levels (31-33) and increased Lp(a) levels have been reported, with 34% of patients having levels above the 75th percentile (34).…”

Section: Hemodialysismentioning

confidence: 99%

Impact of Dyslipidemia in End-Stage Renal Disease

Prichard

2003

Journal of the American Society of Nephrology

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Abstract. Heart disease is a major cause of morbidity and mortality among patients with renal failure. Premature atherosclerotic coronary heart disease is driven by multiple risk factors, including dyslipidemia and oxidative stress. In the nondialysis population, there is overwhelming evidence that treatment of dyslipidemia can significantly improve cardiovascular outcomes. Accumulating data indicate that dialysis patients have atherogenic lipid abnormalities. Although LDL cholesterol (LDL-C) levels in patients who undergo hemodialysis are normal or near normal, increased oxidized LDL-C, triglycerides, and lipoprotein (a) [Lp(a)]; decreased HDL cholesterol (HDL-C); and triglyceride-rich VLDL have been noted. Patients who receive peritoneal dialysis have a more atherogenic lipid profile with increased LDL-C, apolipoprotein B, oxidized LDL-C, triglycerides, and Lp(a) and decreased HDL-C. Furthermore, the LDL particles of peritoneal dialysis patients are small and dense. However, there is a dearth of information regarding the goals, efficacy, and safety of dyslipidemia treatment among dialysis patients. Given the strong evidence of risk reduction and the benefits of lipid-lowering treatment in the nondialysis population, the emerging consensus is that dialysis patients should be treated aggressively for dyslipidemia to an LDL-C goal below 100 mg/dl. Although physicians and patients may be reluctant to add medications because of concerns about polypharmacy, potential decreased compliance, and increased cost, the use of agents such as sevelamer that can serve multiple functions, including phosphate control, lipid lowering (decreased LDL-C and total cholesterol), and anti-inflammatory effects (decreased high-sensitivity C-reactive protein), should be explored and considered for patients who would benefit from such treatment.

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The Uremic Dyslipidemia: A Cross-Sectional and Longitudinal Study

Cited by 98 publications

References 58 publications

Study of thyroid dysfunction and dyslipidemia in chronic kidney diseases

Study of thyroid dysfunction and dyslipidemia in chronic kidney diseases

Incidence of Atherosclerosis by Race in the Dialysis Morbidity and Mortality Study

Impact of Dyslipidemia in End-Stage Renal Disease

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