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Background: Cardiovascular disease is one of the leading cause of death in chronic kidney disease. The increased cardiovascular mortality observed in all stages of Chronic kidney disease patients. In hemodialysis cardiovascular mortality is more than 60%. In hemodialysis dyslipidemia contribute for the triggering of atherosclerosis. Endothelial dysfunction and oxidative stress are serves as main precursor for the progression of atherosclerosis. So the present study was aimed at studying lipid profile and oxidative stress in hemodialysis patients.Methods: A cross sectional study carried out over a 2 year period in Department Nephrology and General Medicine OPD, MIMS, Vizianagaram, Andhra Pradesh, India. A total of 60 hemodialysis patients are included. In all the participants Lipid profile, SOD, MDA and Serum Nitrate was measured. Results: There is a significantly increased levels of serum triglycerides and VLDL in hemodialysis patients when compared with Control. The HDL-C was significant Lower in hemodialysis patients when compared with control. The serum total cholesterol and LDL-C not shown any significant change. The Serum MDA and Serum Nitrate was significantly higher in hemodialysis patients compared with Control and it is statistically significant (p<0.001). Whereas the serum SOD value was significantly decreased in hemodialysis patients when compared with control and it is statistically significant (p<0.001).Conclusion: Present study finding suggested that the incidence of atherosclerosis changes are higher in hemodialysis patients. Early detection and correction of atherosclerosis changes can help us to reducing the deleterious effects.
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Background: Chronic Kidney Disease (CKD) is characterized by irreversible sclerosis and loss of nephrons. The renal mass progressively declines over a prolonged period, depending on the underlying etiology. In CKD the most common feature is hypovitaminosis D which alter the vascular smooth muscle cell proliferation and reprogram the osteoblastic changes, finally leading to increase arterial wall thickness.Methods: A cross sectional study carried out over a 2-year period in Department Nephrology and General Medicine OPD, MIMS, Vizianagaram, Andhra Pradesh, India. 120 in which 60 are normal healthy individuals and 60 are CKD patients with stage 3 to 5. In all the participants serum creatinine, blood urea, serum triglycerides serum total cholesterol, HDL cholesterol estimated and serum 25 OH vitamin D are estimated.Results: The diagnostic criteria for CKD like blood urea, serum creatinine and eGFR were significantly higher in CKD when compared to control. In the present study, systolic and diastolic blood pressure was significantly increased in CKD compared with control. The Carotid Intima Media Thickness (CIMT) both left and right side were significant higher in CKD when compared with control. There is a significantly decreased levels of serum vitamin D in CKD (14.53 ng/mL±6.88) when compared with control (28.87 ng/mL±6.28).Conclusions: Present study finding suggested that there is a raised value of CIMT in CKD patients. High triglycerides, cholesterol and decreased HDL and declined vitamin D low hemoglobin, decreased eGFR, increased systolic blood pressure, raised CIMT value were found to be significantly increased in CKD patients.
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Background: Several clinical trials have been reported that sedentary lifestyle modification including physical activity (PA) and weight loss significantly alters the sort-term as well as long-term incidence of diabetes. The present study explored the level of physical activity and its barriers among south Indian naïve patients who are attending the tertiary care teaching hospital.Methods: A prospective observational, questionnaire-based study. Patients with diabetes (both Type-1 and 2) who were attended diabetic clinic in the Department of General Medicine, Maharaja Institute of Medical Sciences (MIMS), Vijayanagaram, Andhra Pradesh, India was selected and recruited. Demographic data, clinical data were collected from the study participants. International Physical Activity questionnaire was used to determine each patient level of physical activity (PA). Physical activity is graded into low (<600 metabolic equivalent (MET)), moderate (600-3000 MET) and high (>3000 MET).Results: A total of 300 subjects were completed the entire study. Majority (62.7%) of the patients were suffering from Type-2 diabetes mellitus. Both male and female study subjects had low physical activity (70.5% and 74.1%) and moderate PA was seen in only one thirds of the patients. Patients with low physical activity had low glycaemic control compared to patients who were involved in moderate PA. Moderate PA patients had adequate glycaemic control (65.9 vs 34.1%, P <0.001). A total of 42.0% of subjects were suffering from one of the joint pains and friction joints, due to the following reason subjects were not involved in the PA.Conclusions: Low level of physical activity was observed in the study population, which is a risk factor for several micro-vascular complications over a period of time. It is very important to address the barriers of PA and vigorous counselling is needed which directs towards increasing PA.
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Background: In Chronic kidney Disease (CKD) a significant risk factor for mortality is Cardiovascular disease (CVD) and the most prevalent cardiovascular risk factor is left ventricular hypertrophy (LVH). Anemia, hypertension and volume overload are risk factors for LVH in CKD. So, the present was aimed at comparing the risk factors between CKD with and without LVH.Methods: A cross sectional study carried out over a 2 year period in Department Nephrology and General Medicine OPD, MIMS, Vizianagaram, Andhra Pradesh. A total of 120 patients are included in this study and divided in to CKD stage III to V based on estimated GFR. Based on 2D echocardiography data CKD cases are further divided in to CKD with LVH and CKD without LVH.Results: The Left ventricular mass index was significant higher in CKD with LVH (128.89±19.28) when compared with CKD without LVH (108.20±10.28). The left ventricular mass index was noted in more number in stage V of CKD. It is also observed that the left ventricular mass index was negatively correlated with haemoglobin and eGFR and was positively correlated with systolic blood pressure and serum NT-proBNP.Conclusions: Present study finding suggested that the incidence of LVH is higher in CKD patients. LVH was positively correlated with hypertension and NT-proBNP and negatively correlated with anemia and estimated GFR.
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Background: Several observational studies, well controlled randomized trials and meta-analyses reported that patients treated with statins has high risk of new onset diabetes mellitus (NODM), but the exact incidence and mechanism is still unclear and controversy. The present study was planned to find out the incidence of prediabetes and NODM and possible mechanism of action.Methods: This was a prospective, cross‑sectional study carried out at the Department of General Medicine for a period of one and half year between August 2017 and February 2019. Normoglycemic patients whose fasting blood glucose levels below 100 mg/dL and at least one year of treatment with statins were recruited in the study. Glycaemic status, development of prediabetes and NODM and insulin resistance were the primary outcomes whereas lipid profile, adverse drug effects of statins were secondary outcomes. Collected data was analysed by suitable statistical methods.Results: A total of 146 patients were recruited and 120 completed the entire study. Mean fasting blood glucose levels before initiation of statin therapy was 89.45±10.21. After one year of statin therapy, patients were separated as prediabetics and new onset diabetics and there mean fasting blood glucose levels were 116.24±12.86 (n=10) and 152.44±20.12 (n=12) respectively. A total of 12 (10.0%) patients were developed NODM and 10 (8.2%) patients developed prediabetes at the end of statin therapy. Atorvastatin 40mg was most frequency prescribed statin followed by Atorvastatin 20mg. A total of 70 (58.3%) study participants developed mild to moderate drug related adverse effects (ADRs), statin‑induced myalgia (55.7%) was the most common ADR.Conclusions: Patients treatment with statins had developed prediabetes and NODM. Atorvastatin 40mg and greater dose significantly induced NODM. Fasting blood glucose levels should be measured periodically with prescription contains higher doses of statins
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Background: The incidence of ischemic heart disease/ myocardial infarction is rapidly increasing in India. However, the traditional risk factors alone could not explain this excess of Coronary Heart Disease (CHD). So, we are in need of a tool to assess the severity and prognosis of these acute coronary syndromes. Lipoprotein (a) [Lp(a)] and High Sensitive C-Reactive Protein (hs-CRP) have been recognised as independent risk factors for CHD in many retrospective case control studies. As the data shows inconsistency in the prediction of risk by Lp(a) and hs-CRP, the study is carried out to compare and correlate the levels of Lp(a) and hs-CRP in coronary heart disease patients with controls.Methods: An observational case control study was conducted at Maharaja’s Institute of Medical Sciences, Nellimarla, with 120 participants. 80 admitted with CHD were categorised as type 2 diabetic and non-diabetic. Remaining 40 participants were age matched controls, who have attended the OP for general health check-up. Samples collected from the participants were analysed for Lp(a), hs-CRP and HbA1c.Results: Lp(a) levels were significantly elevated in CHD patients with diabetes (69.2±27.5) and non-significant in CHD patients without diabetes (50.4±24.3) as compared to their controls (36.6±22.5). There was significant correlation and elevation of hs-CRP in CHD patients with diabetes (6.0±2.6) and without diabetes (3.7±2.0) as compared to their controls (0.7±0.4).Conclusions: The present study shows a lack of association of Lp(a) levels in CHD patients with and without diabetes. A strong correlation of the inflammatory marker, hs-CRP was observed between the CHD patients with and without diabetes and even as compared to their controls. It may be concluded that hs-CRP is a better and independent marker than Lp(a) in patients with CHD.