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Association Of Renal Dysfunction And Lipid Profile In Cardiac Failure Patients
Article in The International Journal of Science, Mathematics and Technology Learning · December 2022
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International Journal of Science, Mathematics and Technology Learning
ISSN: 2327-7971 (Print) ISSN: 2327-915X (Online)
Volume 30 No. 2, 2022
Association Of Renal Dysfunction And Lipid Profile In Cardiac
Failure Patients
Hamad Imtiaz1, Maryum Shafiq2, Madiha Naheed3, Anam farzand4, Afzal Yasiah5
Superior University Lahore Pakistan.
Abstract
Background: Cardiovascular disease is linked to a number of metabolic abnormalities, including
hypertension, hyperglycemia, and hypercholesterolemia. In chronic kidney disease patients,
cardiovascular diseases are the major cause of death. Chronic kidney disease and cardiovascular
diseases are associated with each other.
Objective: The goal of this study was to look into the relationship between renal dysfunction and lipid
profile in cardiovascular disease.
Main Body: The severity of both diseases increased when occurring side by side. In cardiovascular
disease patients with chronic kidney disease, dyslipidemia is a majr risk factor. Diabetes and
hypertension are the other risks.
Conclusion: In chronic kidney disease patients, the levels of lipid profile were found to be changed
drastically. The levels of triglycerides and low-density lipoprotein are increased in chronic kidney
disease patients but the value of high-density lipoprotein is decreased.
Keywords
Cardiovascular diseases, chronic kidney disease, lipid profile, risks
1. Introduction of cardiovascular disease
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality. The leading causes
include
high
blood
pressure,
tobacco
consumption,
impaired
glucose
tolerance,
and
hypercholesterolemia. The increasing prevalence of CVD is staggering (1). Hypertension is defined as
1
First Author, email: hammad.024@outlook.com
Corresponding Author, email: maryum.shafiq@superior.edu.pk
© Common Ground Research Networks, Maryum Shafiq, All Rights Reserved.
Acceptance: 23Dec2022, Publication: 27Dec2022
3
Third Author, email: madiha.naheed@superior.edu.pk
4
Fourth Author, email: anam.farzand@superior.edu.pk
5
Fifth Author, email: Afzalysaiah788@gmail.com
2
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ISSN: 2327-7971 (Print) ISSN: 2327-915X (Online)
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blood pressure equal to or greater than 140/90 mmHg and is recognized as the most common CVD
and the main cause of death. Hypertension is recognized as the leading reported reason for death.
Hypertension is appropriately called the silent killer because it is usually asymptomatic and
undetected. Hypertension can cause damage to all organs of the body. Hypertensive subjects frequently
have dyslipidemia than non-sensitive subjects. Some studies found an association between
hypertension and hyperglycemia (2).
Table 1: Risk factors of cardiovascular disease
Risk factors of cardiovascular disease
1. Hypertension
2. Diabetes Mellitus
3. Hyperlipidemia
4. Smoking
5. Poor nutrition
6. Obesity
7. Lack of physical activity
1.1 Dyslipidemia and cardiovascular disease
Dyslipidemia is a disorder of lipoprotein metabolism. In dyslipidemia overproduction of the
lipoproteins and deficiency of lipoproteins occurred in the body. The term dyslipidemia actually
defines as the imbalance of lipids such as cholesterol, triglycerides (TG), low-density lipoprotein,
(LDL), and high-density lipoprotein (HDL). The factors like diet, genetics, or tobacco exposure lead
to the progression of dyslipidemia and can result into CVD with severe problems (3). In intestines,
cholesterol and TG are absorbed and carried throughout the body through lipoproteins for energy, bile
acid formation and steroid production (4). Dyslipidemia are of different types. It can also occurred be
owed to the familial disorders as well. In familial hypercholesterolemia, autosomal dominant
mutations occur on LDL receptors, which results in an elevation in LDL levels. Other mutations are
also involved in the cholesterol pathway but are less common (5), (6).
1.2 chronic kidney disease
The term chronic kidney disease (CKD) is defined as any anomaly present more than three months in
the kidney function or kidney structure. According to an estimated glomerular filtration rate (eGFR)
less than 60 mL/min/1.73 m2 and by the presence of persistent kidney damage CKD can be classified.
CKD can be divided into five types which is based on severity of kidney disease: “Normal eGFR with
other evidence of kidney damage, slight decrease in kidney function, moderate decrease in kidney
function, severe decrease in kidney function and end stage kidney disease (ESRD) with eGFR
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ISSN: 2327-7971 (Print) ISSN: 2327-915X (Online)
Volume 30 No. 2, 2022
(mL/min/1.73m2) of >90, 60–89, 45–59, 30–44, 15–29 and <15”. The more advanced stages of CKD
are related to worse prognosis. It results into ESRD, CVD, and death (7).
In CKD patients, dialysis is very helpful to maintain their health conditions. Dialysis is a technique to
purify the blood of CKD patient. Basically, with the help of dialysis the waste products in patient blood
such as urea, creatinine, and excess water are purified. Hemodialysis is actually the most common
form of renal replacement therapy in ESRD and is also used in acute kidney infection. Hemodialysis
involves gaining access to the circulation, either through arteriovenous fistula, a central venous
catheter or an arteriovenous shunt (8). Different equipment’s are involved in this procedure i.e.,
hemodialysis machine, dialyzer, dialysis solution, and needles. The hemodialysis equipment’s are
available in dialysis center and even it can be placed in home. The hemodialysis equipment can pump
blood and regulate blood flow through the dialyzer. It also monitors patient blood pressure, and control
the rate of fluid removal from the body (8).
In this procedure dialyzer is act like an “artificial kidney”. The filters used in dialyzer is equal to the
size of human hair. When the blood passes through the hollow fibers, the dialysis solution also passes
in the opposite direction on the outside of the fibers. The patient blood takes only one second to reach
from top to the bottom of dialyzer. The waste products in patient blood diffuse out in the dialysis
solution (9). A vascular connection is made between an artery and a vein for dialysis. It is durable and
long lasting. The types of vascular access are an arteriovenous fistula and an arteriovenous graft. The
increased blood flow causes the thickness of vein. This vascular access facilitates the large volume of
patient blood purification during the procedure of dialysis.
The arteriovenous fistula is made by surgeon. It is a connection of an artery with a direct vein. Artery
carry blood heart to the other bod parts while vein carries blood from other body parts to towards the
heart. The arteriovenous fistula usually made on arm or fore arm of the patient. The arteriovenous
fistula provides adequate blood flow for dialysis and has a lower complication rate than other types of
access (10). If the patient has some problems with vein then the surgeon made an arteriovenous graft
instead of the arteriovenous fistula. An arteriovenous fistula is basically a connection between an artery
and vein by a synthetic tube that can be bent. The major disadvantage of an arteriovenous fistula that
it is temporary and stays for a short period of time. But if the kidney disease progressed quickly, then
an arteriovenous fistula is better than the arteriovenous fistula (11, 12).
1.3 chronic kidney disease and cardiovascular disease
CVD is the main cause of death in all over world for females and the leading cause of dying in
worldwide. Diverse studies of patients with type 2 diabetes, sudden cardiac death, Infarction, or
hypertensive will almost always include glomerular filtration rate (GFR) as an independent prediction
of deaths. A variety of disorders are also the indicators of lower GFR complicates this analysis. If
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diabetic nephropathy is a potential risk in and of itself, or whether this is just a biomarker of disorders
associated with renal dysfunction. If there was a real correlation among kidneys dysfunction and
mortality, it may imply that measurements of kidney dysfunction were a strong predictor of heart
disease risk. In precision research, blood creatinine is a regularly used standard marker of GFR.
Creatinine levels in blood are linked to all-cause of death or infarction in middle-aged and older
persons, as well as those with insulin-dependent hyperglycemia or a history of heart disease (13).
1.4 Prevalence
The prevalence of dyslipidemia increases with age. The prevalence of coronary heart disease, stroke,
and hypertension with age is shown in figure 1 (14). In 2005-2008 an estimated, the prevalence of
dyslipidemia was 33.5% of Unites States. Adults older than 20 years of age had high LDL levels. Of
these individuals with elevated LDL levels, only 48.1% received treatment, and 33.2% had their LDL
controlled. The prevalence of LDL control seemed to be the lowest amongst individuals that were
uninsured, Mexican American, or had income below the poverty level (15). The highest rates of
cardiovascular diseases was found in South Asians (16). In India, there would be around 62 million
patients with cardiovascular diseases by 2015 and of these, 23 million would be patients younger than
40 years of age (17).
In Europe, by CKD, 4.35 million people are died ever year. CVD followed by CKD is also responsible
for roughly 50% of all deaths (18). From 2011 to 2014, the prevalence of CKD in the USA was
approximately 15% that represents approximately 36 million American adults (19). Heart disease is a
leading cause of CVD in CKD and ESRD patients. According to literature, nearly 30% of CKD patients
also have heart failure. as compared to the CKD patients without heart failure which is just 6% of total
(19). In a large study of about 15000 participants conducted by biracial atherosclerosis risk in
communities. They found that the risk of heart failure is three times greater in individuals with CKD
and ESRD (20). The prevalence of CVD also increases with the severity of CKD. In another study, it
was observed that the prevalence of heart failure is 12 to 36 times more common in dialysis patients
which is 7% per year as compared to the general population (21).
Figure 1: Prevalence of coronary heart disease, stroke, and hypertension with increasing age
1.5 Association between dyslipidemia, chronic kidney disease, and cardiovascular diseases
Males have a larger incidence of CVD risk than females, however this reverses early in adulthood.
Dyslipidemia, which itself is related with high blood pressure, has already been identified as an
autonomous cause of dying, a primary culprit of medical appointments and mortality. Blood
cholesterol are also affected significantly by changes in demographic characteristics. High blood
pressure suffering individuals usually have greater cholesterol levels versus cognitively normal
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individuals. There have been few research to find the association among high blood pressure and
dyslipidemia (22).
Individuals with renal illness are a diverse group with a wide range of etiological factors for renal
disease, degrees of kidney dysfunction and nephropathy, and complications, which together might
influence the degrees and characteristics of systemic TG. The cholesterol profile in some of these
individuals differs from that of the regular populace, with hypertriglyceridemia, decreased numbers of
slightly elevated cholesterol in the blood, and varied amounts of LDL cholesterol and cholesterol and
TG. Hyperglycemia, in fact, is the leading cause of mortality for end-stage diabetic nephropathy, the
most severe form of CKD. The fundamental hypoglycemia quicken the renal harm inflicted by
dyslipidemia (23).
Moderate renal impairment, regardless of the source, is a good determinant of CVD risk in both highrisk individuals and the population in general. The occurrence of micro albuminuria and kidney
throughput of 60 ml/min in high blood pressure compared to those with normal blood creatinine is
related to clinical coronary organ involvement irrespective of blood pressure burden and other
conventional lifestyle factors. These discoveries might explain why these individuals have a worse
circulatory mortality. In addition, hypertension has been linked to the occurrence of significant
vascular events. The findings support the use of regularly measuring estimated GFR and urine albumin
production in clinical practice, not only to assess GFR but also to categorical high blood pressure in
patients with hypertension. A comparable diagnostic method might have important clinical
implications as well. In contrast, official guidelines call for reduced blood pressure values and certain
medication classes to be utilized in this high-risk proportion of patients (24).
GFR disorders have a significant impact on the cardiovascular system. Indeed, myocardial incidence
and death have increasingly been known to be considerably frequent in diabetic people on kidney
transplant treatment when contrasted to age-matched individuals with impaired renal function. It has
lately been shown that endothelial dysfunction grows gradually as GFR drops and has already been
considerably raised though in the five beginning phases of renal impairment. These observations are
indeed further remarkable when someone realizes that a slight loss in GFR is very typical in
hypertension individuals. According with third national health and nutrition examination assessment,
around 13% of all impaired glucose tolerance persons have the illness, systolic blood pressure, fasting
blood sugar, bad cholesterol, LDL cholesterol, such as neovascularization abnormalities and left
ventricular hypertrophy (LVH) (25).
Similarly, numerous studies have demonstrated that uric acid concentration in the body indicate death,
cardiovascular events, and hemorrhage. Several demographic investigations have demonstrated a
favorable connection among serum uric acid and myocardial illnesses also including hemorrhage or
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coronary heart disease. By activating localized endothelial monocytes, the latter creates mono-nuclear
chemo-attractant proteins, neutrophil and macrophages colonial power elements, and granulocyte and
macrophage colony-stimulating variables.
These variables promote the infiltration and transformation of monocytes into eutrophic in walls of the
arteries. The increasing cells of the immune system promote additional LDL degradation. The end
results of this reaction adversely attract apolipoprotein B-100. Because of its enhanced electrostatic
repulsion, this totally oxidized LDL is detected by microglial antioxidant sensors and internalized to
create so-called foam cells. Many investigations have confirmed that the presence of renal
insufficiency worsens the outcome of a range of illnesses (26).
Table 2. Results from different studies
Reference
Year
Findings
Ferro CJ et al (27)
2018
In this review, it was observed that lipid profile level must be managed in chronic kidney
disease patients.
Malik J et al (28)
2018
This review shows that the prevalence of heart failure is more in chronic kidney disease
patients.
Lamprea-Montealegre JA et al (29)
2018
In this study, it was observed that in chronic kidney patients, dyslipidemia was present and the
major cause of cardiac failure.
Braunwald E et al (30)
2019
Diabetes, cardiac failure and renal dysfunctions were associated with each other.
House AA et al (31)
2019
In chronic kidney patients, cardiac failure was the major outcome.
Vallianou NG et al (32)
2019
The pathogenesis of chronic kidney disease and cardiac failure were associated with each other.
So, the prevalence of cardiac failure was high in chronic kidney disease patients.
Wang B et al (33)
2021
The lower level of low-density lipoprotein was strongly associated with cardiac failure and
chronic kidney diseases. They were also observed poor prognosis in those patients.
Jankowski J et al (34)
2021
The prevalence of cardiac failure was high in chronic kidney disease patients.
2. Discussion
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Volume 30 No. 2, 2022
Cardiovascular disease is linked to a number of metabolic abnormalities, including hypertensive,
hyperglycemia, and hypercholesterolemia. In chronic kidney disease patients, cardiovascular diseases
are the major cause of death. Chronic kidney disease and cardiovascular diseases are associated with
each other. The severity of both diseases increased when occurring side by side. In cardiovascular
disease patients with chronic kidney disease, dyslipidemia is a major risk factor. Diabetes and
hypertension are the other risks. In chronic kidney disease patients, the levels of lipid profile were
found to be changed drastically. The levels of triglycerides and low-density lipoprotein are increased
in chronic kidney disease patients but the value of high-density lipoprotein is decreased.
The prevalence of cardiovascular disease is more in our population. It is strongly linked with other
disease like hypertensive, hyperglycemia, and hypercholesterolemia. In present review the association
of renal dysfunction and lipid profile was assessed. In chronic kidney disease patients, cardiovascular
diseases are found the major cause of death. Hyperlipidemia was also linked with cardiac failure.
Patients having abnormal lipid profile levels were more prone to cardiac failure and death in severe
cases. In cardiac failure patients, renal dysfunction and abnormal lipid profile were found. Many
studies support the results of this review (29, 32-34), that there is a strong relationship between renal
dysfunction and lipid profile in cardiovascular disease. To find a proper reason behind these combined
diseases, further researches will be required.
3. Conclusion
It is concluded that there is a strong relationship between renal dysfunction and lipid profile in
cardiovascular disease patients. In chronic kidney disease patient, cardiovascular diseases are the
major cause of death. Patients with dyslipidemia are also developed chronic kidney disease in later
ages. Still, there is a lack of proper diagnosis of cardiovascular diseases in chronic kidney disease
patients in this population. Further strategies are needed to develop proper way of early diagnosis of
cardiovascular diseases.
4. References
1.
Hage FG, Venkataraman R, Zoghbi GJ, Perry GJ, DeMattos AM, Iskandrian AE. The scope of
coronary heart disease in patients with chronic kidney disease. Journal of the American College of
Cardiology. 2009;53(23):2129-40.
2.
Goyal R, Sarwate N. A correlative study of hypertension with lipid profile. Int J Res Appl
Natural Soc Sci. 2014;2:143-50.
3.
Pappan N, Rehman A. Dyslipidemia. StatPearls [Internet]: StatPearls Publishing; 2021.
Page | 919
International Journal of Science, Mathematics and Technology Learning
ISSN: 2327-7971 (Print) ISSN: 2327-915X (Online)
Volume 30 No. 2, 2022
4.
Rader DJ, Hoeg JM, Brewer HB. Quantitation of plasma apolipoproteins in the primary and
secondary prevention of coronary artery disease. Annals of internal medicine. 1994;120(12):1012-25.
5.
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease
and stroke statistics—2016 update: a report from the American Heart Association. circulation.
2016;133(4):e38-e360.
6.
Defesche JC, Gidding SS, Harada-Shiba M, Hegele RA, Santos RD, Wierzbicki AS. Familial
hypercholesterolaemia. Nature reviews Disease primers. 2017;3(1):1-20.
7.
Nephrology OJotISo. KDIGO 2012 Clinical Practice Guideline for the Evaluation and
Management of Chronic Kidney Disease. 2013.
8.
Himmelfarb
J,
Ikizler
TA.
Hemodialysis.
New
England
Journal
of
Medicine.
2010;363(19):1833-45.
9.
Chauveau P, Nguyen H, Combe C, Chêne G, Azar R, Cano N, et al. Dialyzer membrane
permeability and survival in hemodialysis patients. American journal of kidney diseases.
2005;45(3):565-71.
10.
Konner K, Nonnast-Daniel B, Ritz E. The arteriovenous fistula. Journal of the American
Society of Nephrology. 2003;14(6):1669-80.
11.
Misra M. The basics of hemodialysis equipment. Hemodialysis International. 2005;9(1):30-6.
12.
Akoh JA. Prosthetic arteriovenous grafts for hemodialysis. The journal of vascular access.
2009;10(3):137-47.
13.
Nurtazina A, Kozhakhmetova D, Dautov D, Khaidarova N, Chattu VK. Association of Early
Renal Dysfunction with Lipid Profile Parameters among Hypertensives in Kazakhstan. Diagnostics.
2021;11(5):871.
14.
Pal S. Prevalence of cardiovascular disease. US PHARMACIST. 2006;31(2):10.
15.
Control CfD, Prevention. Vital signs: prevalence, treatment, and control of high levels of low-
density lipoprotein cholesterol—United States, 1999-2002 and 2005-2008. MMWR Morb Mortal
Wkly Rep. 2011;60(4):109-14.
16.
Enas EA, Chacko V, Pazhoor SG, Chennikkara H, Devarapalli HP. Dyslipidemia in south
Asian patients. Current Atherosclerosis Reports. 2007;9(5):367-74.
Page | 920
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ISSN: 2327-7971 (Print) ISSN: 2327-915X (Online)
Volume 30 No. 2, 2022
17.
Chauhan S, Aeri BT. Prevalence of cardiovascular disease in India and it is economic impact-
A review. International Journal of Scientific and Research Publications. 2013;3(10):1-5.
18.
Zhang H, Shi S, Zhao X-J, Wang J-K, Liu Z-W, Liu F-Q, et al. Association between the lipid
profile and renal dysfunction in the heart failure patients. Kidney and Blood Pressure Research.
2019;44(1):52-61.
19.
System USRD. 2015 USRDS annual data report: Epidemiology of kidney disease in the United
States. National Institutes of Health, National Institute of Diabetes and Digestive …; 2015.
20.
Kottgen A, Russell SD, Loehr LR, Crainiceanu CM, Rosamond WD, Chang PP, et al. Reduced
kidney function as a risk factor for incident heart failure: the atherosclerosis risk in communities
(ARIC) study. Journal of the American Society of Nephrology. 2007;18(4):1307-15.
21.
Foley RN, editor Clinical epidemiology of cardiac disease in dialysis patients: left ventricular
hypertrophy, ischemic heart disease, and cardiac failure. Seminars in dialysis; 2003.
22.
Dincer N, Dagel T, Afsar B, Covic A, Ortiz A, Kanbay M. The effect of chronic kidney disease
on lipid metabolism. International Urology and Nephrology. 2019;51(2):265-77.
23.
Mohapatra D, Damodar KS. Glycaemia status, lipid profile and renal parameters in progressive
diabetic neuropathy. Journal of Clinical and Diagnostic Research: JCDR. 2016;10(9):CC14.
24.
Norimatsu K, Gondo K, Kusumoto T, Motozato K, Suematsu Y, Fukuda Y, et al. Association
between lipid profile and endothelial dysfunction as assessed by the reactive hyperemia index. Clinical
and Experimental Hypertension. 2021;43(2):125-30.
25.
Hammad SM, Hunt KJ, Baker NL, Klein RL, Lopes-Virella MF. Diabetes and kidney
dysfunction markedly alter the content of sphingolipids carried by circulating lipoproteins. Journal of
Clinical Lipidology. 2022.
26.
Jayakala T. A Study on eGFR, Protein-Creatinine ratio, Thyroid and Lipid Profile on assessing
risk factor for renal dysfunction: Trichy SRM Medical College Hospital & Research Centre, Trichy;
2019.
27.
Ferro CJ, Mark PB, Kanbay M, Sarafidis P, Heine GH, Rossignol P, et al. Lipid management
in patients with chronic kidney disease. Nature Reviews Nephrology. 2018;14(12):727-49.
28.
Malik J. Heart disease in chronic kidney disease–Review of the mechanisms and the role of
dialysis access. The journal of vascular access. 2018;19(1):3-11.
Page | 921
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ISSN: 2327-7971 (Print) ISSN: 2327-915X (Online)
Volume 30 No. 2, 2022
29.
Lamprea-Montealegre JA, McClelland RL, Grams M, Ouyang P, Szklo M, De Boer IH.
Coronary heart disease risk associated with the dyslipidaemia of chronic kidney disease. Heart.
2018;104(17):1455-60.
30.
Braunwald E. Diabetes, heart failure, and renal dysfunction: the vicious circles. Progress in
cardiovascular diseases. 2019;62(4):298-302.
31.
House AA, Wanner C, Sarnak MJ, Piña IL, McIntyre CW, Komenda P, et al. Heart failure in
chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO)
Controversies Conference. Kidney international. 2019;95(6):1304-17.
32.
Vallianou NG, Mitesh S, Gkogkou A, Geladari E. Chronic kidney disease and cardiovascular
disease: is there any relationship? Current cardiology reviews. 2019;15(1):55-63.
33.
Wang B, Chen S, Liu J, Liang Y, Meng L, Yan X, et al. Association between baseline LDL-C
and prognosis among patients with coronary artery disease and advanced kidney disease. BMC
nephrology. 2021;22(1):1-8.
34.
Jankowski J, Floege J, Fliser D, Böhm M, Marx N. Cardiovascular disease in chronic kidney
disease: pathophysiological insights and therapeutic options. Circulation. 2021;143(11):1157-72.
Page | 922
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