RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / Name of the candidate and address (In block letters)Permanent Address / :
: / Dr. CHANDRASHEKAR
DEPARTMENT OF GENERAL MEDICINE
NAVODAYA MEDICAL COLLEGE & HOSPITAL,
RAICHUR – 584103.
Dr.CHANDRASHEKAR
S/O BHOJANA GOUDA
AT POST- HOSPET, VIA –YARAMARAS
TQ/DIST- RAICHUR,584132
2. / Name of the institution / : / NAVODAYA MEDICAL COLLEGE,HOSPITAL & RESEARCH CENTRE
RAICHUR – 584103.
3. / Course of study and subject / : / M.D.(GENERAL MEDICINE)
(3 ACADEMIC YEARS)
4. / Date of admission to the course / : / 31-05-2012
5. / Title of the topic / : / LIPID ABNORMALITY IN CHRONIC KIDNEY DISEASE
6.1 / Need for the study:
Chronic kidney disease (CKD) is a serious condition associated with premature mortality, decreased quality of life, and increased health-care expenditures.1,2,3 The prevalence of end-stage renal disease continues to rise worldwide. Chronic Renal Failure (CRF) is the state which results from a permanent and usually progressive reduction in renal function, in a sufficient degree to have adverse consequence on other systems.4
In India incidence of CRF is not well documented because of lack of national registry and data regarding its incidence. It has been estimated that the prevalence of CRF in India may be up to 800 people per million population and the incidence of end-stage renal disease (ESRD) is 150–200 pmp.5
The most common cause for mortality in these patients include cardiovascular, cerebrovascular and peripheral vascular diseases. Death due to cardiovascular complications is 4-20 fold higher in CRF patients than any other cause in general population.6 Furthermore, people with chronic kidney disease tend to have an excess of traditional risk factors for cardiovascular disease, such as hypertension, diabetes, and hyperlipidemia.7Lipid abnormalities can be detected as early as renal function begins to decline (Glomerular Filtration Rate (GFR) < 50ml/min) but the type and severity vary among different patients.
Most characteristic lipid abnormality is increased serum triglycerides, very low density lipoprotein (VLDL), intermediate density lipoprotein (IDL) and low levels of high density lipoprotein (HDL).6,8
In recent times dyslipidemia has been identified as a major risk factor for coronary artery disease. This has renewed interest in the identification and management of abnormalities in the plasma lipids and lipoprotein.9
CRF patients are subjected to enhanced oxidative stress due to reduced antioxidant systems and increased pro oxidant activity.10 The magnitude of the problem has become more apparent in the recent years as a result of an increase in the life span of the patients due to the advent of hemodialysis. The incidence of coronary artery disease is seen in 26 percent of dialysis patients.11
Hence there is a need to study association of dyslipidemia in chronic kidney disease.
6.2 / Review of literature
· L.S. IBELS et al12, in their study showed that hypertriglyceridemia was a fairly constant observation in patients of chronic renal failure and cholesterol were variable, often normal.
· SM Alam et al13 in their study showed that while serum cholesterol levels were similar, serum triglycerides were significantly higher and HDLC significantly lower in the uremic patients as compared to controls.
· G. Avasthi et al14, in their study showed that lipid Metabolism was altered in CRF patients and triglyceride was elevated as compared to normal subjects.
· John D. Bagdade et al15 in their study showed that hypertriglyceridemia was the metabolic consequences of chronic renal failure.
· King W. Ma et al16, showed that lipid abnormalities of chronic renal failure are important cardiovascular risk factors.
· Thomas Quaschning et al17, in their study showed the relationship between the abnormalities in uremic lipoprotein metabolism and its impact on cardiovascular disease.
· Ziad A. Massy et al18 in their study demonstrated that dyslipidemia, particularly low HDL cholesterol, is a significant risk factor.
· Bhansali A S et al19, in Nagpur conducted study on dyslipidemia in patients of chronic renal failure and hypertriglyceridemia was shown to be associated with chronic renal failure.
· Marion Morena et al20 in their study showed the protective effects of high density lipoprotein against oxidative stresses.
· In a study by Shah and colleagues21, They found that the total cholesterol, HDL and LDL level was not significantly different in these groups of patients when compared to normal subjects of the same age. They however found that the triglyceride levels were significantly elevated in patients with CKD on conservative management as compared to the post transplant and dialysis.
6.3 / Objectives of the study
1. To assess the lipid abnormalities in Chronic kidney disease.
7 / Materials and methods
7.1 / Source of Data:
Cases of chronic renal failure attending the outpatient department or admitted in the Navodaya medical college hospital and research centre , Raichur .
7.2 / Methods of collection of Data (including sampling procedure, if any)
Sample size: 100 subjects
Design of study : Cross sectional study
Study period : One year between July 2013 to June 2014
Method of study:
· All the selected patients will be subjected to detailed history and complete physical examination and data collected will be noted in a pre-designed proforma.
Inclusion criteria:
Patients of chronic kidney disease on conservative or hemodialysis irrespective of other co-existing diseases
Exclusion criteria:
1. Renal transplant patients
2. Patients on lipid lowering drug.
7.3 / Does the Study require any investigation or intervention to be conducted on Patients or other humans or animals? If so, please describe briefly.
Yes, following investigations will be required :
INVESTIGATIONS:
• Blood: Hb% TC DC ESR
• Urine: Albumin ,Sugar, Microscopy, Specific Gravity
• Blood Urea: Serum Creatinine , Fasting blood sugar
Post prandial blood sugar
• Serum electrolytes
• Lipid profile
• ECG
• USG abdomen
• Serum calcium
• Serum phosphorus
7.4 / Has ethical clearance been obtained from your institution in case of 7.3?
Yes
8. / List of references:
1. Go A S, Chertow GM, Fan D, McCulloch CE, Hsu C. Chronic kidney diseases and the risk of death, cardiovascular events, and hospitalization. N Eng J Med 2004;351:1296-305.
2. Briet M, Bozec E, Laurent S, Fassot C, London GM, Jacquot C et al. Arterial stiffness and enlargement in mild-to-moderate chronic kidney disease. Kidney Int 2006;69:350–57.
3. Anavekar NS, McMurray JJ, Velazquez EJ, Solomon SD, Kober L, Rouleau JL et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med 2004; 351:1285–1295 .
4. Winearls CG. Chronic Renal failure In : Warrell DA, Cox TM, Firth JD, Benz EJ,Eds. Oxford text book of Medicine 4th edn, Vol 3. New York, Oxford University press; 2003:263-278.
5. Agarwal SK, Srivastava RK.Chronic Kidney Disease in India Challenges and Solutions” Nephron Clin Pract 2009; 111:c197–c203 (minireview).
6. Oda H, Keane WF. Lipid abnormalities in end stage renal disease. Nephrol Dial Transplant 1998;13(Suppl 1):45-49.
7. Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL et al.Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in cardiovascular disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 2003; 108:2154-69.
8. Wanner C. Importance of hyperlipidaemia and therapy in renal patients. Nephrol Dial Transplant 2000;15(Suppl 5):92-96.
9. Grundy SM. Cholesterol and coronary heart disease: A new era. JAMA 1986; 256: 2849-58.
10. Locatelli F, Canaud B, Eckardt KU, Stenvinkel P, Wanner C, Zoccali C. Oxidative stress in end-stage renal disease: an emerging threat to patient outcome. Nephrol Dial Transplant 2003;18:1272-1280.
11. Gokal RJ. Outcome in patients on continuous ambulatory peritoneal dialysis and hemodialysis. Lancet 1987; 14: 1105-9.
12. L.S Ibels, L.A Simons, J.O King, P.F Williams,F.C Neale, JH Stewart et al studies on the nature and causes of hyperlipidemia in uremia, maintenance dialysis and renal transplantation. Quart J Med 1975;176:601-614 .
13. SM Alam, AK Bhatt, Abnormal lipoprotein in uremic patients treated conservatively and by maintainance hemodialysis. J Assoc phy India 1991;99:170-171.
14. G. Avasthi, Devinder Mittal, G.L.Soni. lipid profile of patients of chronic renal failure. Indian J. Med res 1986;84:612-616.
15. John D. Bagdade, John J. Albers. Plasma high density Lipoprotein concentrations in chronic hemodialysis and renal transplant patients N Engl J Med 1977;1436-39.
16. King W.Ma , Green EL, Raij L. Cardiovascular risk factors in chronic renal failure and hemodialysis populations. Am J of Kidney diseases 1992; 19(6): 505-15.
17. Thomas Quaschning, Vera Krane, Thomas Metzger, Christoph Wanner. Abnormalities in uremic Lipoprotein Metabolism and it’s impact on cardiovascular disease. Am J kidney dis 2001;38:S14-S19 .
18. Ziad A Massy, Thao Nguyen Khoa, Bernard Lacour, Beatrice Descamps-Latscha, paul Jungers. Dyslipidemia and the progression of renal disease in chronic renal failure patients. Nephrol dial translant 199;14:2392-2397
19. Bhansali AS, Kumbhalkar SD, Salkar HR, Salkar RG. Dyslipidemia in patients of chronic renal failure on dialysis. J Assoc phy India 2003;51:1272 .
20. Marion Morena, Jean-Paul Cristol, thierry Dantoine,Marrie-Annette Carbonn eau, Bernard Descomps, Bernard Canaud et al. protective effects of high-debnsity lipoprotein against oxidative stress are impaired in haemodialysis patients. nephrol dial transplant 2000;15:389-393.
21. Shah B, Nair S, Sirsat RA, Ashavaid TF, Nair K. Dyslipidemia in patients with chronic renal failure and in renal transplant patients. J Postgrad Med 1994; 40:57-6
9. / Signature of the Candidate
10. / Remarks of the Guide / CKD and dyslipidemia independently has significant morbidity and mortality and is common in this part of north Karnataka with scanty studies. This study is recommended to assess the morbidity and mortality because of dyslipidemia and CKD.
11. / Name & Designation of Guide
(in block letters)
11.1 Guide / DR. CHAITANYA KUMAR S
ASSOCIATE PROFESSOR
DEPARTMENT OF GENERAL MEDICINE.
NAVODAYA MEDICAL COLLEGE & HOSPITAL RAICHUR-584103
11.2 Signature
11.3 Co-Guide (If any)
11.4 Signature
11.5 Head of the Department / DR. S S ANTIN
PROFESSOR AND HEAD
DEPARTMENT OF GENERAL MEDICINE.
NAVODAYA MEDICAL COLLEGE & HOSPITAL RAICHUR-584103
11.6 Signature
12 / 12.1 Remarks of the Chairman
& The Principal
12.2 Signature
1