Early Cardiovascular Risk Markers in Uremia: A New Insight

Cardiovascular disease is a major cause of morbidity and mortality in patients with chronic kidney disease (CKD). Endothelial dysfunction, inflammation, hyperhomocysteinemia, oxidative stress etc. have been implicated in the pathogenesis of atherosclerosis in CKD patients after dialysis. The present study was therefore undertaken to determine the significance of Nitric oxide (NO), markers of oxidative stress - malondialdehyde (MDA) and total antioxidant capacity (TAC), and hypoalbuminemia as novel uremia-related risk markers of atherosclerotic vascular disease in predialytic CKD patients.

The study included 100 subjects, of which 50 were chronic kidney disease patients(with serum creatinine > 1.5 mg/dl) and 50 age and sex matched healthy controls. In both cases and controls, serum NO (modified Greiss's method), MDA (modified colorimetric method of Satoh), TAC (FRAP assay method of Benzie and Strain) and serum albumin (BCG colorimetric method) were measured. Blood sugar, lipid profile, serum creatinine, BUN, serum protein and electrolytes were estimated in both cases and controls by standard clinical chemistry methods.

CKD cases had significantly lower levels of NO, TAC and albumin than in controls. MDA levels were significantly higher in CKD cases, compared to healthy controls. There was a positive correlation between serum creatinine with serum albumin.

Our findings of decreased nitric oxide levels, hypoalbuminemia along with oxidative stress may serve as early novel markers of atherosclerosis which progresses with renal failure. Our study helps in early detection of cardiovascular disease before the patient undergoes dialysis and helps in preventing cardiovascular complications in chronic kidney disease.