Selenium in atherosclerotic complications of chronic renal failure

Trace elements disturbance may occur in uraemic patients and patients on haemodialysis, as a result of renal function decline. Selenium [Sc] deficiency seems to have a synergistic effect with alterations in plasma lipids in promoting the progression of atherosclerotic lesions. The aim of this study was to investigate the possible effect of Se in the development of atherosclerotic complications in chronic renal failure patients. One hundred and seventeen individuals were randomly selected, fifty five patients with primary end stage renal failure on regular hemodialysis treatment, mean age 38.94 +/- 13.00 years, [group I], fourty patients with chronic end stage renal failure under conservative treatment, mean age 48.25 +/- 12.07 years, [group II] and twenty two healthy control volunteers with mean ages 38.09 +/- 9.66 years, [group Ill]. Full history and clinical examinations, stressing on macrovascular atherosclerotic complications were done. Laboratory investigations included serum[s] lipids profile [total lipids, total cholesterol [TC], phospholipids phosphorus [PLP], triacylglycerol [TG] and lipoproteins [alpha lipoprotein [HDL], pre-betalipoprotein [VLDL] beta lipoprotein [LDL] and lipoprotein [a] [Lp [a]]]. Determination of superoxide dismutase enzyme [SOD], Se and renal function tests and cardiovascular assessment were done. In group I and group II patients there were significant increase of the serum levels of TC [p < 0.05] and TG [p < 0.001], on contrast to significant decrease of HDL [P < 0.01], SOD and Se [p < 0.001] as compared to group III normal control. In groups I and II patients there were non significant difference of total lipids, LDL, Lp [a], PLP and VLDL [p > 0.05] on comparing with group III control. In the correlation between Se and other parameter in the patients groups there were negative correlation significant with TG, urea and creatinine and non significant with total lipids, TC, LDL, Lp [a] and insulin. On the contrary there was significant positive correlation with PLP and SOD while non significant with HDL, VLDL, glucose and age. We concluded that chronic renal failure patients have significant Se deficiency which may be contributed to the associated dyslipidemic atherosclerotic complications with high incidence in uremic patients on conservative treatment 24/40 [60%] than patients on hemodialysis 19/55 [34.5%]. We recommend to use 1-More objective evidence of atherosclerosis in more number of patients 2-Lipid lowering agents with low fat diet regimen is advisable to chronic renal failure patients 3-Se supplementation to chronic renal failure patients

Iron in Dyslipidemic atherosclerotic development and the role of the antioxidant superoxides Dismutase in chronic renal failure patients

Over the past decade, researchers have hypothesized that iron plays a role in the development of atherosclerosis. Abnormalities of lipoproteins are common in patients with chronic renal failure and contribute to the high incidence of cardiovascular diseases. Iron stores per se increase the risk of oxidized low density lipoprotein which is a crucial pathogenic factor in atherosclerosis and the levels ofantioxidant have an important protective role. The aim of this study was to investigate the possible role of iron in the development of atherosclerosis in chronic renal failure patients. One hundred and seventeen individuals were randomly selected, fifty five patients with primary end stage renal failure on regular hemodialysis treatment with mean ages 38.94 +/- 13.00 years, [group I], fourly patients with chronic end stage renal failure under conservative treatment with mean ages 48.25 +/- 12.7 years, [group II] and twenty two healthy control volunteers with mean ages 38.09 +/- 9.66 years, [group III]. Full history and clinical examination with stressing on macrovascular atherosclerotic complications were done. Laboratory investigations included serum[s] lipids profile total lipids, total cholesterol [TC], phospholipids phosphorus [PLP], triacylg-lycerol [TG] and lipoproteins [alpha lipoprotein [HDL], pre-betalipoprotein [VLDLJ, beta lipoprotein [LDL] and lipoprotein [a][Lp [a]|], fasting blood glucose [FBG], insulin, S iron[l], ferritin [Ft], percentage of transferrin saturation [Tsat] and total iron binding capacity [TIBC]. In addition to renal function tests, cardiovascular assessment and Superoxide dismutase enzyme [SOD] were done. In group I and group II patients there were significant increase of the serum levels of TC [p<0.05], TG [p<0.001] and Ft [p<0.001] in contrast to significant decrease of HDL [p<0.01], SOD [p<0.001], SI and Tsat [p<0.01] as compared to group III. Group II showed significant decrease of TIBC [p>0.05] in comparison to group I and group III. In groups I and II patients there were non significant differences of total lipids, LDL, Lp[a] PLP and VLDL [p>0.05] in comparison to group III. The correlation coefficient between iron parameters and lipids profile levels in the patients groups showed, non significant negative correlation between iron parameters with total lipids, while there was significant negative correlation between SI with TC, TG and LDL [r=-0.232, -0.197, -0.252 respectively] and between Tsat with TC [r=-0.245]. Also significant but positive correlation was observed between SI and Tsat with HDL [r=0.305 and 0.261 respectively] and between TIBC with SOD [r=0.303]. In conclusion, group I and II chronic renal failure patients showed iron deficiency and decreased SOD activity .which has an important protective role. Dyslipidemia was obvious in form of significance increased TC, TG with significant decrease of HDL. Although the direct evidence of involvement of iron parameters in atherosclerotic chronic renal failure complications are still obscure, the atherosclerotic complications in group I and group II patients accounted 34.5% and 60% respectively where ischemic heart diseases were 23.6% and 30%' respectively. So we recommend to use 1- More objective evidence of atherosclerosis procedures in more number of patients. 2- Lipids lowering agents with low fat diet-regimen is advisable to chronic renal failure patients. 3- Best way of safety when giving iron therapy orally or intravenously to chronic renal failure patients