The Effect of Haemodialysis on Lipid Peroxidation and Lipid Atherogenic Risk Ratios as a Predictor of Cardiovascular Disease

Abstract

Introduction: Cardiovascular risk factors are prevalent in Haemodialysis (HD) patients. Aim: To assess the effect of HD on lipid peroxidation marker (Malondialdehyde (MDA)), lipid atherogenic ratios, and peripheral inflammatory markers in HD patients. Materials and Methods: A cross-sectional case-control study was conducted on 60 patients on regular HD attending nephrology unit of Luxor general hospital between June 2016 and May 2017, (33 males/27 females) and 30 healthy controls (17 males/13 females) were enrolled. Blood samples were obtained for estimation of lipid profile, MDA, and complete blood counts. One-way analysis of variance (ANOVA) was used for comparisons between groups, receiver operator characteristic curve was performed to obtain the cut-off value of MDA, sensitivity, specificity, and area under the curve was used to discriminate between HD patients and controls. The correlation study was used to measure the relationship between variables. Logistic Regression (Odd’s Ratio) was performed for calculation of cardiac risk factors for heart attack in HD cases. Results: HD patients had significantly low WBCs (p=0.010) and lymphocyte counts (p<0.00001); with insignificant difference between pre- and post-HD. HD-patients had significantly higher cholesterol (p=0.019), triglycerides, VLDL-c, MDA (p<0.00001) and non-HDL-c (p=0.002) all increased significantly post-HD. Inversely, HDL-c was significantly lower in HD-patients and decreased significantly in post-HD (p<0.00001). HD-patients had significantly higher indexes for (TC/HDL, LDL/HDL, VLDL/ HDL, TG/HDL, Non-HDL/HDL) (p<0.00001), monocyte: HDL ratio (p=0.003) and Platelet: Lymphocyte Ratio (PLR) (p=0.042) all significantly increased post-HD. Inversely; HD-patients had significant lower LDL/VLDL (p<0.00001) and Lymphocyte: Monocyte Ratio (LMR) (p=0.0003) with insignificant difference between pre- and post-HD. However, Neutrophil: Lymphocyte Ratio (NLR) (p=0.095), monocyte count (p=0.626) showed insignificant difference. MDA was correlated with TG, VLDL, non-HDL/HDL, and TG/HDL; but multivariate regression analysis indicates inter-related variables and none was considered independent risk factor. Conclusion: HD worsens oxidative stress caused by uraemia and accentuates lipid peroxidation and dyslipidemia present in HD patient. Lipid peroxidation and dyslipidemia are probable independent modifiable risk factor that contributes to high morbidity and mortality by promoting cardiovascular complications.

Keywords

• dyslipidemia
• end stage renal disease
• inflammatory markers
• malondialdehyde
• oxidative stress