Biochemical Assessment of Atherosclerosis in Sudanese Patients with Chronic Renal Failure on Hemodialysis Maintenance Therapy

Background: Renal manifestations are becoming a very important health problem in the developing world. In Sudan, the new cases account for about 70-140 thousand of inhabitants per year. Leading to reduced quality of life, these manifestations have negative social and economic impact on the population.

Atherosclerosis is a very frequent complication in uremia due to the coexistence of hypertension, hyperhomocysteinemia, inflammation, malnutrition, increased oxidative stress and hyperlipidemia.

Alteration in structural and functional ability of high-density lipoprotein cholesterol (HDL), Low-density lipoprotein cholesterol (LDL), apolipoprotein (A), apolipoprotein (B), and Lipoprotein (a) were also associated with atherosclerosis.

Purpose: The aim of this study was to determine serum level of total cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol, lipoprotein (a), fibrinogen and homocysteine as markers for atherosclerosis and to measure plasma homocysteine to assess endothelial Cell Dysfunction and vascular disease.

Materials and Methods: A total of one hundred patients with Chronic Kidney Disease on Dialysis and one hundred sex and age-matched healthy control subjects were enrolled in this study; after informed consent six milliliters of venous blood were collected after hemodialysis session from each patient and healthy subjects after an overnight fasting in a plain container from which serum is separated and then stored in Eppendorf tubes at -80C°. Before analysis, frozen specimens were thawed and allowed to reach room temperature for various measurements.

Results: The results showed that there was increased in the mean level of serum triglycerides (277.45±59.47) (P. value >0.001), Lp(a) (60.29±20.66) (P. value >0.001), Homocysteine (24.30±6.37) (P. value >0.001)and Fibrinogen (498.66±56.48) (P. value >0.001) among the Chronic Kidney Disease patients on maintenance hemodialysis therapy when compared to the control group.

The results also showed that there was a reduced level of HDL-cholesterol (24.76±6.46) (P. value >0.001) among the Chronic Kidney Disease stage on dialysis when compared to the control group.

Furthermore, the results showed that there was positive correlation between serum Lipoprotein (a) with plasma fibrinogen level and homocysteine

Conclusion: In conclusion, the significant increase in Plasma triglyceride concentration, Lp (a), Homocysteine and Fibrinogen level, as well as decreased HDL-Cholesterol level among CKD patients on regular hemodialysis maintenance therapy place them at risk of developing cardiovascular disease.

This risk is also evident in the positive correlation between serum Lipoprotein (a) with plasma fibrinogen level and homocysteine and these findings showed that homocysteine enhanced the binding of Lipoprotein (a) to Fibrin and this interaction linked between Thrombosis and Atherosclerosis.