Hemodiyaliz Hastalarında Yüksek Serum Ürik Asit/HDL-Kolesterol Oranı Kardiyovasküler Risk ile İlişkilidir

Yıl 2022, , 159 - 166, 29.04.2022

Ahmet Cizmecioglu , Mevlüt Hakan Göktepe , Hilal Akay Çizmecioglu , Zeynep Bıyık , Yasemin Coşkun Yavuz , Lütfullah Altıntepe

https://doi.org/10.54005/geneltip.1041116

Öz

Amaç: Kronik böbrek hastalığı (KBH), kardiyovasküler (KV) komorbiditelerin sık olduğu ilerleyici bir hastalıktır. Yüksek ürik asit/HDL-kolesterol oranı (UHR) sonuçlarının periton diyalizi alan hastalarda dikkate değer bulunmuştur. Bu çalışmada bu nedenle diyaliz hastalarında UHR sonuçlarını değerlendirmeyi amaçladık.
Gereç ve yöntem: Bu retrospektif, çok merkezli, kesitsel çalışma KBH hastaları ile normal glomerüler filtrasyon hızına (GFR) sahip hipertansif hastaları içeren bir kontrol grubu ile yürütüldü. Laboratuvar, ayaktan kan basıncı takibi ve demografik kayıtları iki üniversite hastanesinin dahiliye ve nefroloji bölümlerinden temin edildi. Hasta grubu daha sonra GFR'ye göre beş alt gruba ayrıldı.
Bulgular: Çalışmaya toplam 124 KBH hastası ve 127 kontrol katıldı. Tüm KBH hastaları ayrıca prediyalitik ve diyalitik olarak tanımlandı. KBH'li grupta UHR, non-dipper kan basıncı paterni ve gece kalp hızı (KH) kontrol grubuna göre artmıştı. Non-nipper KH ve gece KH, yüksek UHR’si olan diyaliz hastalarında prediyalitik olanlara göre hastalık progresyonuyla daha anlamlıydı. HbA1c’si hedefte olan diyabetik hastalardan yüksek UHR'leri olanlarda hala gece diyastolik KB yükselmeleri vardı. Son olarak, nabız dalga hızı için evreye özel bir sonuç yoktu.
Sonuç: Sonuçlarımıza göre, yüksek UHR'leri olan diyaliz hastaları, KV riskle ilişkili olarak daha yüksek non-dipper PR, gece KH ve gece diyastol kan basıncına sahiptir. Ayrıca, yüksek UHR'leri olan diyaliz hastalarında etkili bir diyabet yönetimi KV riskini önlemeyebilir.

Anahtar Kelimeler

Ambulatuar kan basıncı takibi, Diabetes mellitus, Hemodiyaliz, Kardiyovasküler risk, Yüksek yoğunluklu lipoprotein, Serum ürik asidi.

Destekleyen Kurum

yok

Proje Numarası

yok

Elevated Serum Uric Acid to HDL-Cholesterol Ratio is Related to Cardiovascular Risk in Patients Receiving Hemodialysis

Öz

Aim: Chronic kidney disease (CKD) is a progressive disease in which frequent cardiovascular (CV) comorbidities. High uric acid to HDL-cholesterol ratio (UHR) results were quite notable in patients receiving peritoneal dialysis. Thus, in this study, we aimed to evaluate the UHR results in dialysis patients.
Materials and Methods: This retrospective, multicenter, cross-sectional study was conducted with CKD patients, and the control group consisted of hypertensive patients with a normal glomerular filtration rate (GFR). Patients’ laboratory, ambulatory blood pressure monitoring, and demographic records were obtained from the follow-up cases of two university hospitals’ internal medicine and nephrology departments. The patients' group then were divided into five subsets according to GFR.
Results: A total of 124 CKD patients and 127 control participated in this study. All CKD patients were also identified as pre-dialysis and dialysis. The cases of UHR, non-dipper blood pressure pattern, and nocturnal heart rate (HR) were increased in CKD compared to the control group. Per disease progression, the non-dipper HR and nocturnal HR were more significant in patients receiving dialysis with high UHR than in the pre-dialysis subset. In diabetic patients with an on-targeted HbA1c, those with high UHRs still had nocturnal diastolic BP elevations. Finally, there was not an exact stage-specific result for pulse wave velocity.
Conclusions: Based on our results, dialysis patients with high UHRs have higher non-dipper PR, nocturnal heart rate, and nocturnal diastole blood pressure, associated with CV risk. Moreover, effective diabetic management might not prevent CV risk in dialysis patients with high UHRs.

Anahtar Kelimeler

Ambulatory blood pressure monitoring, Cardiovascular risk, Diabetes mellitus, Hemodialysis, High-density lipoprotein, Serum uric acid.

Proje Numarası

yok

Kaynakça

• 1. Meola M, Samoni S, Petrucci I. Clinical Scenarios in Chronic Kidney Disease: Kidneys' Structural Changes in End-Stage Renal Disease. Contrib Nephrol 2016;188:131-43.
• 2. Cha RH, Lee H, Lee JP, Kim YS, Kim SG. The influence of blood pressure patterns on renal outcomes in patients with chronic kidney disease: The long-term follow up result of the APrODiTe-2 study. Medicine (Baltimore) 2020;99(8):e19209.
• 3. Swinkels DW, Hendriks JC, Nauta J, de Jong MC. Glomerular filtration rate by single-injection inulin clearance: definition of a workable protocol for children. Ann Clin Biochem 2000;37 ( Pt 1):60-6.
• 4. Vaidya SR, Aeddula NR. Chronic Renal Failure. StatPearls. Treasure Island (FL)2020.
• 5. Muniz-Junqueira MI, Braga Lopes C, Magalhaes CA, Schleicher CC, Veiga JP. Acute and chronic influence of hemodialysis according to the membrane used on phagocytic function of neutrophils and monocytes and pro-inflammatory cytokines production in chronic renal failure patients. Life Sci 2005;77(25):3141-55.
• 6. Mataradzija A, Resic H, Rasic S, Kukavica N, Masnic F. Risk factors for development of cardiovascular complications in patients with chronic renal disease and diabetic nephropathy. Bosn J Basic Med Sci 2010;10 Suppl 1:S44-50.
• 7. Guerrero A, Montes R, Munoz-Terol J, et al. Peripheral arterial disease in patients with stages IV and V chronic renal failure. Nephrol Dial Transplant 2006;21(12):3525-31.
• 8. Zaoui P, Hannedouche T, Combe C. [Cardiovascular protection of diabetic patient with chronic renal disease and particular case of end-stage renal disease in elderly patients]. Nephrol Ther 2017;13(6S):6S16-6S24.
• 9. Tonelli M, Muntner P, Lloyd A, et al. Risk of coronary events in people with chronic kidney disease compared with those with diabetes: a population-level cohort study. Lancet 2012;380(9844):807-14.
• 10. Major RW, Cheng MRI, Grant RA, et al. Cardiovascular disease risk factors in chronic kidney disease: A systematic review and meta-analysis. PLoS One 2018;13(3):e0192895.
• 11. Che X, Mou S, Zhang W, et al. The impact of non-dipper circadian rhythm of blood pressure on left ventricular hypertrophy in patients with non-dialysis chronic kidney disease. Acta Cardiol 2017;72(2):149-55.
• 12. Baka T, Simko F. Nondipping heart rate: A neglected cardiovascular risk factor based on autonomic imbalance? Auton Neurosci 2018;210:83-4.
• 13. Pehlivanlar-Kucuk M, Kucuk AO, Ozturk CE, Er MC, Ulger F. The Association Between Serum Uric Acid Level and Prognosis in Critically Ill Patients, Uric Acid as a Prognosis Predictor. Clin Lab 2018;64(9):1491-500.
• 14. Correia LC, Rocha MS, Esteves JP. HDL-cholesterol level provides additional prognosis in acute coronary syndromes. Int J Cardiol 2009;136(3):307-14.
• 15. Aktas G, Kocak MZ, Bilgin S, Atak BM, Duman TT, Kurtkulagi O. Uric acid to HDL cholesterol ratio is a strong predictor of diabetic control in men with type 2 diabetes mellitus. Aging Male 2019:1-5.
• 16. Zhang YN, Wang QQ, Chen YS, Shen C, Xu CF. Association between Serum Uric Acid to HDL-Cholesterol Ratio and Nonalcoholic Fatty Liver Disease in Lean Chinese Adults. Int J Endocrinol 2020;2020:5953461.
• 17. Liu R, Peng Y, Wu H, et al. Uric acid to high-density lipoprotein cholesterol ratio predicts cardiovascular mortality in patients on peritoneal dialysis. Nutr Metab Cardiovasc Dis 2021;31(2):561-9.
• 18. Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150(9):604-12.
• 19. Raja S, Kumar A, Aahooja RD, Thakuria U, Ochani S, Shaukat F. Frequency of Hyperuricemia and its Risk Factors in the Adult Population. Cureus 2019;11(3):e4198.
• 20. Dybro AM, Damkier P, Rasmussen TB, Hellfritzsch M. Statin-associated rhabdomyolysis triggered by drug-drug interaction with itraconazole. BMJ Case Rep 2016;2016.
• 21. Martin SS, Blaha MJ, Elshazly MB, et al. Friedewald-estimated versus directly measured low-density lipoprotein cholesterol and treatment implications. J Am Coll Cardiol 2013;62(8):732-9.
• 22. Cuspidi C, Meani S, Negri F, Valerio C, Sala C, Mancia G. Is blunted heart rate decrease at night associated with prevalent organ damage in essential hypertension? Blood Press Monit 2011;16(1):16-21.
• 23. Ozarda Y, Ichihara K, Aslan D, et al. A multicenter nationwide reference intervals study for common biochemical analytes in Turkey using Abbott analyzers. Clin Chem Lab Med 2014;52(12):1823-33.
• 24. Kowall B, Rathmann W. HbA1c for diagnosis of type 2 diabetes. Is there an optimal cut point to assess high risk of diabetes complications, and how well does the 6.5% cutoff perform? Diabetes Metab Syndr Obes 2013;6:477-91.
• 25. Zawada AM, Carrero JJ, Wolf M, et al. Serum Uric Acid and Mortality Risk Among Hemodialysis Patients. Kidney Int Rep 2020;5(8):1196-206.
• 26. Chang TI, Streja E, Soohoo M, et al. Association of Serum Triglyceride to HDL Cholesterol Ratio with All-Cause and Cardiovascular Mortality in Incident Hemodialysis Patients. Clin J Am Soc Nephrol 2017;12(4):591-602.
• 27. Li M, Ye ZC, Li CM, et al. Low serum uric acid levels increase the risk of all-cause death and cardiovascular death in hemodialysis patients. Ren Fail 2020;42(1):315-22.
• 28. Wang W, Liu W, Zhao Z, Zhao Y, Zhao C. High uric acid or low uric acid which is better for hemodialysis patients? Ren Fail 2020;42(1):759.
• 29. Igase M, Kohara K, Igase K, et al. Deep cerebral microbleeds are negatively associated with HDL-C in elderly first-time ischemic stroke patients. J Neurol Sci 2013;325(1-2):137-41.
• 30. Perrella J, Berco M, Cecutti A, Gerulath A, Bhavnani BR. Potential role of the interaction between equine estrogens, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) in the prevention of coronary heart and neurodegenerative diseases in postmenopausal women. Lipids Health Dis 2003;2:4.
• 31. Federici AB. HDL/ApoA-I: role in VWF-dependent thrombosis. Blood 2016;127(5):526-8.
• 32. Cetin EH, Cetin MS, Canpolat U, et al. Monocyte/HDL-cholesterol ratio predicts the definite stent thrombosis after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Biomark Med 2015;9(10):967-77.
• 33. Brown WV. The disparity between the very strong performance of high-density lipoprotein (HDL) cholesterol as a risk factor and the very weak effects. Foreword. J Clin Lipidol 2010;4(1):1.
• 34. Espinosa-Larranaga F, Vejar-Jalaf M, Medina-Santillan R, Latin American G. The importance of low serum levels of high-density lipoprotein cholesterol (HDL-C) as a cardiovascular risk factor. Diab Vasc Dis Res 2005;2 Suppl 1:S1-8.
• 35. Onat A, Can G, Ornek E, Altay S, Yuksel M, Ademoglu E. Elevated serum uric acid in nondiabetic people mark pro-inflammatory state and HDL dysfunction and independently predicts coronary disease. Clin Rheumatol 2013;32(12):1767-75.
• 36. Sinnakirouchenan R, Holley JL. Peritoneal dialysis versus hemodialysis: risks, benefits, and access issues. Adv Chronic Kidney Dis 2011;18(6):428-32.
• 37. Wei X, Wen Y, Zhou Q, et al. Hyperlipidemia and mortality associated with diabetes mellitus co-existence in Chinese peritoneal dialysis patients. Lipids Health Dis 2020;19(1):234.
• 38. Rahman M, Griffin V, Heyka R, Hoit B. Diurnal variation of blood pressure; reproducibility and association with left ventricular hypertrophy in hemodialysis patients. Blood Press Monit 2005;10(1):25-32.
• 39. Hamrahian SM, Falkner B. Hypertension in Chronic Kidney Disease. Adv Exp Med Biol 2017;956:307-25.
• 40. MacRae C, Mercer SW, Guthrie B, Henderson D. Comorbidity in chronic kidney disease: a large cross-sectional study of prevalence in Scottish primary care. Br J Gen Pract 2021;71(704):e243-e9.
• 41. Sequi-Dominguez I, Cavero-Redondo I, Alvarez-Bueno C, Pozuelo-Carrascosa DP, Nunez de Arenas-Arroyo S, Martinez-Vizcaino V. Accuracy of Pulse Wave Velocity Predicting Cardiovascular and All-Cause Mortality. A Systematic Review and Meta-Analysis. J Clin Med 2020;9(7).