ABSTRACT
Patients with End Stage Renal Disease (ESRD) on dialysis have 2 to 5-fold more coronary artery calcification (CAC) than age-matched individuals. Leptin receptors are expressed in atherosclerotic lesions, and leptin signaling has been implicated in the promotion of vascular calcification. In this study, we evaluated the role of Serum Leptin in coronary artery calcification in ESRD patients on dialysis. Methods: This study was done on 50 CKD-ESRD patients on maintenance dialysis and 20 normal subjects. Plasma leptin was measured in all CKD-ESRD patients and normal control by DRG Leptin ELISA Kit. Blood samples were obtained for analysis of leptin prior to dialysis. All patients with ESRD and normal subjects were subjected to Multi Row Spiral Computed Tomography (MSCT) for detection of coronary artery calcification scoring (CACS). Results: The mean serum leptin value in ESRD subjects was 8.91+ 1.42 ng/ml. The mean serum leptin value in normal subjects was 3.14 + 0.61 ng/ml. This difference in serum leptin value between ESRD on dialysis and normal subjects was statistically significant (Z=2.91, p< 0.05). The mean CACS in 50 patients with ESRD was 91.4 + 32.7 Agatston units. The mean CACS in normal subjects was 7.75 + 6.5 Agatston units. Difference in prevalence of CACS between ESRD patients on dialysis and normal subjects was statistical significant. In ESRD patients on dialysis with CACS in range 0-10, 11-100 and 101-400 Agatston units, the mean serum leptin values were 3.1 + 0 ng/ml, 6.2 + 3.4 ng/ml, 14.3 + 3.5 ng/ml respectively. So it was evident that with increase in CACS, the serum leptin values also increased. The difference in the serum leptin concentration between the group with CACS in the range of (0-10), (11-100), (101-400) Agatston units were statistically significant. [(z=5.16, p < 0.05), (z= 7.8, p< 0.05) respectively)]. Conclusion: CAC is amplified in renal patients and it progresses rapidly with advancement of the disease. Our study results suggest a positive co relation with Serum leptin and CAC in ESRD patients. In ESRD patient’s serum leptin is elevated as compared to normal subjects. Hence, we conclude that controlling serum leptin will reduce CAC burden.
ABSTRACT
Patients with End Stage Renal Disease (ESRD) on dialysis have 2- to 5-fold more coronary artery calcification than age-matched individuals. One hypothesis for the disproportionate calcification burden in these patients is high serum phosphate levels; patients with chronic kidney disease (CKD) have elevated serum phosphate and calcium phosphorus product as a consequence of both reduced phosphate filtration and secondary hyperparathyroidism. Methods: This study was done on 50 CKD – ESRD patients on maintenance dialysis sand 20 normal subjects. Blood sample were obtained for serum Calcium, Phosphate, Parathyroid hormone of all CKD-ESRD patients prior to dialysis and of normal controls. All subjects were subjected to Multi Row Spiral Computed Tomography for detection of coronary artery calcification scoring (CACS). Results: The mean value of corrected Calcium Phosphorus product was 50.9 ± 15.6 mg2/dl2 in ESRD patients. The minimum value was 26.04mg2/dl2 and maximum value of the product 85.7 mg2/dl2 in ESRD patients. The mean CACS in 50 patients with ESRD was 91.4 ± 32.7agatston units. For CACS score 0-10,11-100,101-400 agatston unit the Calcium Phosphorus product was 26.04 ± 0, 45.18 ± 12.75, 63.31 ± 10.18 mg2/dl2. With increase in CACS, the Calcium Phosphorus (CaXPO4) products increased and this association was statistically significant. The CACS values in normal subjects were 7.75 ± 6.5 Agatston units. Conclusion: Our study results suggest a positive association between Calcium Phosphorus product and CAC in ESRD patients. Controlling Calcium Phosphorus product will reduce the coronary artery calcification burden.