Sah Shiv Kumar, Adhikary Laxman Prasad
Department of Pharmacy, Purbanchal University, Little Buddha College of Health Science, Kathmandu, Nepal.
Gastro and Liver Foundation, Kathmandu, Nepal.
Int J Nephrol Renovasc Dis. 2020 Sep 24;13:211-218. doi: 10.2147/IJNRD.S267252. eCollection 2020.
Patients with CKD have a higher prevalence of dyslipidemia and hypovitaminosis than the normal population. Recent studies in the general population have shown a potential link between 25(OH)D and dyslipidemia. However, such evidence in the early CKD population, especially in the Nepalese setting, is lacking. Thus, the present study aimed at investigating the status of 25(OH)D and dyslipidemia in the early CKD patients, and further to establish an association between 25(OH)D and lipid profile.
In this cross-sectional study, we analyzed 136 clinically stable non-dialyzed CKD patients. 25(OH)D and lipid profile were evaluated as a core variable, and their direction and magnitude of a relationship were evaluated.
The estimated prevalence of dyslipidemia was 49.3%, and 63.2% population had a deficiency of 25(OH)D level. Compared with the patient with normal 25(OH)D level, the patient with deficient 25(OH)D level had a significantly higher level of LDL-c (=0.04) and lower level of HDL-C (=0.048). Serum 25(OH)D level was significantly lower in dyslipidemic patients than non-dyslipidemic patients (=0.015). Regression analysis demonstrated a significant inverse relationship between serum 25(OH)D levels and LDL-c (β=-1.5; =<0.001), and TC levels (β=-1.4;=0.003), and the association remained unchanged with further adjustment for age, sex, HTN, DM, serum albumin and eGFR.
Our study unveiled a high rate of dyslipidemia and hypovitaminosis in a considerable number of early CKD patients. Low serum level of 25(OH)D was significantly correlated with a higher rate of dyslipidemia. These findings indicate some evidence for 25(OH)D level as a marker of dyslipidemia prediction, and that decrease in serum level of 25(OH)D is associated with increased serum level of LDL and TC; it could increase the risk of cardiovascular disease. Therefore, early recognition and timely management of hypovitaminosis and dyslipidemia is vital to prevent an inevitable cardiovascular event.
慢性肾脏病（CKD）患者血脂异常和维生素缺乏症的患病率高于正常人群。普通人群的近期研究表明，25（OH）D与血脂异常之间可能存在联系。然而，在早期CKD人群中，尤其是在尼泊尔的环境中，缺乏此类证据。因此，本研究旨在调查早期CKD患者中25（OH）D和血脂异常的状况，并进一步建立25（OH）D与血脂谱之间的关联。
在这项横断面研究中，我们分析了136例临床稳定的未透析CKD患者。将25（OH）D和血脂谱作为核心变量进行评估，并评估它们之间关系的方向和程度。
血脂异常的估计患病率为49.3%，63.2%的人群25（OH）D水平缺乏。与25（OH）D水平正常的患者相比，25（OH）D水平缺乏的患者低密度脂蛋白胆固醇（LDL-c）水平显著更高（P=0.04），高密度脂蛋白胆固醇（HDL-C）水平更低（P=0.048）。血脂异常患者的血清25（OH）D水平显著低于非血脂异常患者（P=0.015）。回归分析表明，血清25（OH）D水平与LDL-c（β=-1.5；P<0.001）和总胆固醇（TC）水平（β=-1.4；P=0.003）之间存在显著的负相关，在进一步调整年龄、性别、高血压、糖尿病、血清白蛋白和估算肾小球滤过率（eGFR）后，这种关联保持不变。
我们的研究揭示了相当数量的早期CKD患者中血脂异常和维生素缺乏症的高发生率。低血清25（OH）D水平与较高的血脂异常发生率显著相关。这些发现表明，有一些证据支持将25（OH）D水平作为血脂异常预测的标志物，并且血清25（OH）D水平的降低与血清LDL和TC水平的升高相关；这可能会增加心血管疾病的风险。因此，早期识别和及时管理维生素缺乏症和血脂异常对于预防不可避免的心血管事件至关重要。
