Sains Malaysiana 47(1)(2018): 149–155

http://dx.doi.org/10.17576/jsm-2018-4701-18

Evaluating Cardiovascular Risk in Chronic Kidney Disease Patients: A Biomarker Approach

(Menilai Risiko Kardiovaskular pada Pesakit Buah Pinggang Kronik: Pendekatan Penanda Biologi)

ABDUL HALIM ABDUL GAFOR*, ROZITA MOHD, RIZNA CADER, KONG WEI YEN, MARLYN MOHAMAD, SHAMSUL AZHAR SHAH, ARBAIYAH BAIN & NORELLA CT KONG

Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Wilayah Persekutuan, Malaysia

Received: 14 June 2016/Accepted: 16 June 2017

ABSTRACT

Cardiovascular disease (CVD) is a major cause of morbidity and mortality in chronic kidney disease (CKD) patients. This study aimed to determine the roles of CVD biomarkers in CKD patients. This was a case-control study which recruited consecutive patients with stage 2-4 CKD patients with and without CVD. Serum levels of highly-sensitive C reactive protein (hs-CRP), cystatin C (CysC), asymmetrical dimetylarginine (ADMA) and symmetrical dimethylarginine (SDMA) were measured. Sixty two stage 2-4 CKD patients with a mean age of 60.3 ± 10.4 years were recruited. Twenty three (37.1%) of them had CVD. Those CKD patients with CVD were older (64.1±8.0 vs 58.1± 1.1, p<0.05) and had significantly higher systolic blood pressure (139.4 ± 16.2 vs 129.4 ± 14.8 mmHg, p<0.05). Diabetic patients had 8 times (95% CI 1.25-51.77, p< 0.05) higher risk to develop CVD. CKD patients with CVD had a higher serum creatinine (185.0 ± 54.1 vs 154.1 ± 54.4 μmol/L, p<0.05), a lower estimated glomerular filtration rate (33.7 ± 12.2 vs 42.2 ± 14.5 mL/min/1.73m² p<0.05) and a lower triglyceride levels (1.3 (1.1-1.7) vs 1.8 (1.4-2.3) mmol/L, p<0.05), compared to those without CVD. Fasting blood sugar was 7.1 ± 2.7 mmol/L in CVD group and 6.3 ± 1.6 mmol/L in non CVD group (p>0.05). There were no differences in their mean serum levels of hs-CRP, CysC, ADMA and SDMA. Risk factors including age, diabetes mellitus, hypertension and renal functions were still the most important CVD risk factors in CKD patients.

Keywords: Asymmetrical dimetylarginine; biomarker; cardiovascular disease; chronic kidney disease; cystatin C

ABSTRAK

Penyakit kardiovaskular (CVD) adalah punca utama morbiditi dan kematian kepada pesakit buah pinggang kronik (CKD). Kajian ini bertujuan untuk menentukan peranan penanda biologi kardiovaskular dalam kalangan pesakit CKD. Ini adalah satu kajian kes-kawalan yang melibatkan pesakit CKD peringkat 2-4 dengan dan tanpa CVD. Tahap serum protein reaktif C sensitif berdaya tinggi (hs-CRP), sistatin C (CysC), asimetri dimetilarginin (ADMA) dan simetri dimetilarginin (SDMA) diukur. Enam puluh dua pesakit CKD peringkat 2-4 dengan purata umur 60.3 ± 10.4 tahun telah diambil. Dua puluh tiga (37.1%) daripada mereka mempunyai CVD. Pesakit CKD dengan CVD yang lebih tua (64.1 ± 8.0 berbanding 58.1 ± 1.1, p<0.05) dan mempunyai tekanan darah sistolik yang lebih tinggi (139.4 ± 16.2 berbanding 129.4 ± 14.8 mmHg, p<0.05). Seperti yang dijangka pesakit kencing manis mempunyai 8 kali (95% CI 1.25-51.77, p<0.05) risiko yang lebih tinggi untuk mendapat CVD. Pesakit CKD dengan CVD mempunyai nilai serum kreatinin yang lebih tinggi (185.0 ± 54.1 berbanding 154.1 ± 54.4 μmol/L, p<0.05 lebih rendah anggaran kadar penapisan glomerul (33.7 ± 12.2 berbanding 42.2 ± 14.5 mL/min/1.73 m², p<0.05 dan tahap trigliserida yang lebih rendah (1.3 (1.1-1.7) berbanding 1.8 (1.4-2.3) mmol/L, p<0.05) berbanding dengan mereka yang tidak mempunyai CVD. Paras gula berpuasa adalah 6.8 ± 2.5 mmol/L di dalam kumpulan CVD dan 7.0 ± 2.9 mmol/L dalam kumpulan bukan CVD (p>0.05). Tidak ada perbezaan dalam tahap serum hs-CRP, CycC, ADMA dan SDMA mereka. Kesimpulan daripada kajian ini adalah faktor risiko CVD tradisi seperti umur, penyakit kencing manis, darah tinggi dan fungsi buah pinggang masih adalah faktor risiko CVD yang paling penting dalam pesakit CKD.

Kata kunci: Asimetri dimetilarginin; penanda biologi; penyakit buah pinggang kronik; penyakit kardiovaskular; sistatin C

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*Corresponding author; email; halimgafor@gmail.com