Chronic Kidney Disease is a global health problem. The reported prevalence of chronic kidney disease in different regions ranges from 1% to 13% and recently data from the International Society of Nephrology’s Kidney Disease Data Center Study reported a prevalence of 17%¹. The etiology of chronic kidney disease varies considerably throughout India. Parts of the states of Andhra Pradesh, Odisha and Goa have high levels of chronic kidney disease of unknown etiology which is a chronic interstitial nephropathy with insidious onset and slow progression².

Chronic kidney disease is associated with specific abnormalities in the lipoprotein metabolism both in the early and in theadvanced stages of chronic renal failure. It has been suggested that the renaldyslipo protein aemia of renal insufficiency contributes to the progression of glomerular and tubular lesions, with subsequent deterioration of renal function. Regardless of age, heart disease is a major cause of morbidity and mortality among patients with renal failure. Cardiovascular disease is a major cause of mortality and morbidity in patients with mild to moderate chronic kidney disease³

Renal failure refers to “a condition, in which there is a loss of normal function of kidneys, due to various factors which include infections, auto-immune diseases, diabetes and other endocrine disorders, cancer and toxic chemicals. In chronic renal failure the deterioration of function of kidney gradually occurs and leading to accumulation of associated problems over years. This condition cannot be reversed however its progress can be slowed down and eventually leads to the development of the symptoms of end-stage renal failure^{. 4}

Chronic kidney disease is a progressive and irreversible deterioration in the function of kidney over months to years⁵ which is defined as “glomerular filtration rate (GFR) lesser than 60 ml/min with protenuria for 3 months”. It leads to various biochemical disturbances and numerous clinical symptoms and signs.^6-7

The lipid abnormalities, characteristically, reported among Chronic renal failure patients are increased triglyceride levels, normal or reduction in total cholesterol (TC), decrease in levels of HDL, normal LDL levels. Progressive Chronic renal failure, can not only lead to End stage renal disease but is also related to higher cardiovascular morbidity & mortality. Due to significant role of plasma lipids in the pathogenesis of atherosclerosis and ischemic heart disease, it becomes worthy for studying the role of various lipid fractions in Chronic renal failure patients. Main cause of death is cardiovascular disease among ESRD patients and exclusively among hemodialysis compared to transplantation patients.⁸

AIM AND OBJECTIVE

To estimate and analyze serum lipid levels in the ESRD patient undergoing hemodialysis.

Study Design: The present study was a Cross-sectional observational study.

Study Setting: The study was conducted in Department of Medicine, S.P. Medical College, PBM and Associated group of Hospitals, Bikaner (Rajasthan).

Study Population: The study was conducted among the patients diagnosed with chronic kidney disease (End Stage Renal Diseases) on haemodialysis admitting in the ward of medicine department of our hospital during November 2023 to November 2024.The study inclusion and exclusion criteria are given below:

Inclusion Criteria:

1. Patients of both sex male and female
2. Age above 20 years
3. Patients with End Stage Renal Disease (CKDStage 5) on Haemodialysis
4. Willing to participate in the study

Exclusion Criteria:

1. Patients who do not fill the above criteria
2. Pregnant women
3. Patients with Diabetes Mellitus
4. Patients already on lipid lowering drug therapy

Data Management and Satistical Analysis:

Sample size of 100 cases were taken including fulfilling the eligibility criteria. written informed consent was obtained from all participants.The data was entered and analysed systematically. Categorical variables were summarized as percentages and quantitative variables were summarised as mean with standard deviation (SD), or median with inter-quartile range (IQR) according to the distribution of variable.

Figure 1. Age Wise distribution of cases

Figure 1. shows Age Wise distribution of cases. In our study maximum 39% cases were seen in the Age group of 46- 60 years age followed by 29.00% in 61-80 yr age and 20% were in 31–45 yr whereas minimum 1.00% in >80 yr followed by 11% in 18 – 30 yr age group. The mean age of study population was 61.81 ± 13.45 yr with age range of 18 – 90 yr.

Figure 2. Distribution of cases according to sex

Figure 2. In present study, 72% were male and rest 28% were female.

Table 1. Distribution of cases according to LDL cholesterol levels

Table 1. In present study, 55(55.00%) cases had their LDL cholesterol level <100mg/dL, 15 (15.00%) had their LDL cholesterol level was 101-129mg/dL and 30(30.00%) cases had their LDL cholesterol level ≥130mg/dL. Mean LDL cholesterol was 99.09 ± 39.49 mg/dL.

Table2. Effect of hemodialysis on lipid profile

Table 2. In present study, increased LDL in 30 cases, 48 cases had increased triglyceride, and 40 cases had increased total cholesterol whereas decreased HDL was seen in 69 cases.

Chronic kidney disease results when a disease process affects the structural or functional integrity of the kidneys. Chronic kidney failure is the result of CKD. Cardiovascular disease is a major cause of mortality in patients with mild-to-moderate CKD and ESRD. dyslipidemia has been established as a well-known traditional risk factor for cardiovascular disease in general population and it is well known that patient with CKD exhibits significant alterations in lipoprotein metabolism, which, in their most advanced form, may result in the development of severe dyslipidemia.

In our study maximum 39% cases were seen in the Age group of 46- 60 years age followed by 29.00% in 61-80 yr age and 20% were in 31–45 yr whereas minimum. The mean age of study population was 61.81 ± 13.45 yr with age range of 18 – 90 yr. Similarly Sharanappa Patil et al^.(9)Among 56 cases, the mean age was 51.2 years with the range of 45–57 years. Also Mohit Verma et al.⁽¹⁰⁾the mean age of the study population was 42.45±16.24 years.

In our study, 72% were male and rest 28% were female. Also Mohit Verma et al^.(10) included 59.0% males and 41.0% females with more number of males than females. The study by Maheshwari al⁽¹⁵⁾ included 50 patients with end-stage renal disease on maintenance hemodialysis  which comprised of 31 males and 19 females.

In present study, 60 (60%) cases had their total cholesterol normal (<200mg/dL) while 40 (40.00%) cases had their increased total cholesterol level (>200 mg/dL). Mean total cholesterol was 174.07 ± 52.11 mg/dL. Similarly Sharanappa Patil et al.⁽⁹⁾ found that the mean total cholesterol in the CRF cases was 213.6 mg/dL This observation was similar to the results obtained by Kimak et al⁽¹¹⁾in their work on plasma lipoproteins in CRF patients. They also concluded that total cholesterol is not increased significantly in patients with CRF. Also Mohit Verma et al.⁽¹⁰⁾ the mean total Cholesterol level was 137.13±40.01.

In present study, 48 (48.00%) cases had increased triglyceride (>150mg/dL) while decreased in 48 (48.00%) cases had their total cholesterol level <150mg/dL. Mean triglyceride was 142.09 ± 45.20 mg/dL. Similarly Sharanappa Patil et al.⁽⁹⁾ Mean triglycerides was 205.9 mg in cases and 148 mg/dL in controls (p-value 0.0001). our results were in concordance with the work done by Kimak et al^(11), in which they demonstrated significant increase in triglycerides, LDL, and Apo-B concentrations. In another study done by Bhagwat et al⁽¹²⁾ they concluded that CRF patients were having marked triglyceridemia of 232 mg/dL as compared with controls (p-value < 0.01). Another Indian study on dyslipidemia in patients with CRF and renal transplantation by Shah et al⁽¹³⁾ demonstrated that triglycerides level was elevated significantly in CRF patients on conservative management. These results show that hypertriglyceridemia is an important lipid abnormality in patients with CRF. Also Mohit Verma et al⁽¹⁰⁾ the mean Triglycerides level was 161.59±56.04. Almost similar results were reported by Mohanraj et al⁽¹⁴⁾ mean triglyceride of the study group was found to be 197.26 mg/dl (178.18 mg/dl). control group.

In present study, 69(69.00%) cases had their HDL cholesterol level <40mg/dL while decreased in 31 (31.00%) males had their HDL cholesterol level <40mg/dL. Mean HDL cholesterol was 36.74 ± 7.62 mg/dL. Similarly Sharanappa Patil et al⁽⁹⁾ demonstrated a significant decrease in HDL in CRF cases when compared with controls (39 vs 60.7 mg/dL, p-value 0.001). also the results obtained by Bhagwat et al were similar, where they found HDL-C to be significantly low (20±11) mg/dL (p-value less than 0.001) in CRF groups. Patients with CKD generally have reduced plasma HDL-C concentrations when compared with nonuremic individuals. also Mohit Verma et al⁽¹⁰⁾found that the mean HDL Cholesterol level was 44.99±15.35.

In present study, 55(55.00%) cases had their LDL cholesterol level <100mg/dL, 15 (15.00%) had their LDL cholesterol level was 101-129mg/dL and 30(30.00%) cases had their LDL cholesterol level ≥130mg/dL. Mean LDL cholesterol was 99.09 ± 39.49 mg/dL. Similarly, Sharanappa Patil et al. ⁽⁹⁾ demonstrated an increase in LDL-C between cases and controls (139.4 vs 127.2 mg/dL). p-value (0.1031). Also, Bhagwat et al ⁽¹²⁾ where they found that LDL-C in CRF patients showed an increase compared with controls, which is not statistically significant. Study by Kimak et al ⁽¹¹⁾ showed results not comparable to our study. The LDL-C showed significant increase among CRF patients compared with controls in their study. Although the total concentrations of LDL are not significantly increased, there is predominance of small dense particles which are particularly susceptible to oxidation in CRF. These small particles are thought to be more atherogenic than larger LDL substrates. Also, Mohit Verma et al ⁽¹⁰⁾ found that the mean LDL Cholesterol level was 64.84±30.96.

In our study, increased LDL in 30 cases and 48 cases had increased triglyceride, 40 cases had increased total cholesterol whereas decreased HDL was seen in 69 cases. Disturbances in lipoprotein metabolism (mainly accumulation of intact or partially metabolized apolipoproteinB-containing particles as well as reduced concentrations of HDL-cholesterol) are evident even at the early stages of CKD and usually follow a decreasing pattern that parallels the deterioration in renal function. Since several intrinsic (genetic, primary kidney disease) or exogenous (drugs, method of renal replacement) factors can influence the phenotypic expression of these alterations, the precise knowledge of the pathophysiological mechanisms that underlie their development is of paramount importance”.

“Hemodialysis is the process which can effectively reduce the accumulation of nitrogenous waste products but fails to clear dyslipidemias generated during the course of CRF. But still the patients on hemodialysis are still exposed to several of the metabolic consequences of renal failure. On the basis of the findings of the present study, it is further suggested that prescribing lipid lowering treatment in CRF patients with dyslipidemias for preventing future episode of cardiovascular events could help and will also preserve renal function. A strict monitoring lipid profile and lipoproteins can reduce the morbidity and mortality rate and will also improve the quality of life of CRF patients”.

Lipid abnormalities are common in CRF. Total cholesterol and Triglycerides show statistically significant increase in CRF cases. The LDL-C is increased in CRF patients. The HDL-C shows a statistically significant decrease in CRF patients.

“Our results indicated that patients undergoing CRF show important abnormalities of lipid metabolism which could contribute to atherosclerosis and cardiovascular disease and may increase the morbidity and mortality in these patients”

Therefore, dyslipidemia is common complication of CKD. The lipoprotein abnormalities may influence the progression of renal failure. Chronic kidney disease patient’s dyslipidemia and its complications are more prevalence. Hence early diagnosis of dyslipidemia indicated potential therapeutic approaches like therapeutic life style changes and pharmacotherapy should be initiated to limit the long-term consequences of cardiovascular disease in this population.

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