Journal of Clinical and Diagnostic Research. 2018 Sep, Vol-12(9): BC05-BC09 5 5 DOI: 10.7860/JCDR/2018/35432.11983 Original Article Biochemistry Section Pre and Post Dialysis Variations in Serum Lipid Profile among End Stage Renal Disease Patients KARRA MADHU LATHA 1 , BHONGIR APARNA VARMA 2 ABSTRACT Introduction: Chronic Kidney Disease (CKD) is a devastating disease and 50% of CKD patients die from Cardiovascular Disease (CVD) rather than End Stage Renal Disease (ESRD). Dyslipidaemia is a major contributor of CVD in these patients. The exact effect of Renal Dialysis (RD) on lipid parameters in ESRD is not clearly elucidated. Aim: To assess the variations in serum lipid profile and study the pattern of lipoproteins by agarose gel electrophoresis before and after RD. Materials and Methods: In this case-control study, 30 ESRD patients (15 male and 15 female) receiving maintenance renal dialysis were taken as cases and 30 age and sex matched healthy individuals were recruited as controls. Lipid profile parameters were estimated in Siemens automated analyser. Lipoprotein electrophoresis was done on Sebia Semi automated analyser. The data were analysed using GraphPad prism. Student’s t-test for normally distributed data, Mann-Whitney U test for non- normally distributed data and ANOVA for comparison of more than two groups was done. A p-value <0.05 was considered statistically significant. Results: In ESRD cases there was a significant increase (p <0.001) in Total Cholesterol (TC), Low Density Lipoprotein Cholesterol (LDL-C), High Density Lipoprotein Cholesterol (HDL-C) after RD compared to the values before RD (151.4±38.92 versus 183±57.18 mg/dL; 75.3±24.66 mg/dL versus 84.23±29.74; 31.9±9.74 mg/dL versus 35.57±12.49 mg/dL); respectively. Triglycerides (TG) and Very Low Density Lipoprotein (VLDL) values decreased after RD compared to the values before RD (123.6±50 versus 121.4±49.26; 24.73±10 versus 24.29±9.85); (p>0.05). Fractionation of lipoproteins reveals a significant increase in lipoprotein a {Lp(a)} as compared to controls (21.20±17.46 versus 12.38±10.63, p<0.05). The values of alpha and beta lipoproteins in electrophoresis didn’t correlate well with the values obtained from automated enzymatic lipoprotein measurements in ESRD cases after dialysis (r=0.22, p=0.18). Conclusion: There is a remarkable increase in atherosclerotic risk after RD noted due to significant increase in TC, LDL-C and Lp(a) which might increase the risk of CVD in RD subjects. INTRODUCTION Chronic kidney disease is defined as a permanent and significant reduction in Glomerular Filtration Rate (GFR) [1]. The estimated prevalence of CKD in India is up to 785 people per million populations [2]. Several studies have revealed that more than 50% of CKD patients die from CVD rather than develop ESRD [3-5]. The predominant cause of CVD is dyslipidaemia along with increased incidence of both traditional and non-traditional risk factors [6]. The most distinctive lipid abnormality in these patients is increased TG, VLDL and Intermediate Density Lipoprotein (IDL) due to reduced clearance of these triglyceride-rich lipoproteins and low levels of HDL-C [7]. LDL-C may remain normal quantitatively but gets altered qualitatively. Oxidative stress, hyperhomocysteinaemia and alterations in lipid metabolism observed in haemodialysis patients could increase LDL-C oxidation [8]. Lipid abnormalities not only increase the risk of atherosclerosis and CVD but also play a crucial role in the initiation and progression of glomerular and tubulo-interstitial diseases [9]. The renal replacement therapy, the mainstay of the management of CKD is beyond the reach of a large number of CKD patients in many developing countries, including India [10]. Maintenance Renal Dialysis (MRD) is the supportive treatment for such patients [11]. Dialysis is effective for amelioration of uremic symptoms and its toxicity. The effect of haemodialysis on LDL-C and HDL-C inflammatory properties is not known. Dialysis may attenuate LDL-C inflammatory activity and restore HDL-C anti-inflammatory properties by removing the potential pro-oxidant and proinflammatory uremic toxins. Conversely, LDL-C and HDL-C inflammatory activities can be transiently intensified due to exposure to dialyser membrane and tubing, mechanical stress in the roller pump, and influx of impurities from dialysate compartment during haemodialysis [12]. Treatment for hyperlipidaemia in the primary and secondary prevention of CVD is well recognised in the general population while the treatment of hyperlipidaemia in the dialysis population has remained controversial [13]. Indian studies on the effect of RD on dyslipidaemia are indeterminate and inconsistent [14,15]. There is insufficient data on the effect of single RD session on lipoproteins in ESRD patients on MRD [16]. Hence, the present study was delineated to assess alterations in the lipoproteins before and after the procedure in a single RD session. MATERIALS AND METHODS A case-control study was conducted at Mediciti Hospitals, Hyderabad, Telangana, India, from December 2012-June 2014. A total of 30 ESRD patients (GFR <15 mL/minutes/1.73 m 2 ) who were maintained on regular maintenance renal dialysis at Mediciti Hospitals after excluding the exclusion criteria {Obesity (Body mass index >24 kg/m 2 ), nephrotic syndrome, acute renal failure, patients Keywords: Cardiovascular disease, Chronic kidney disease, Dyslipidaemia, Lipoprotein agarose gel electrophoresis