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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2017  |  Volume : 28  |  Issue : 1  |  Page : 183-185
Prevalence of dyslipidemia and macrovascular complications among post kidney transplant patients


1 Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
2 Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

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Date of Web Publication12-Jan-2017
 

How to cite this article:
Gunawardena KW, Wijewickrama ES, Carukshi A, Lanerolle RD. Prevalence of dyslipidemia and macrovascular complications among post kidney transplant patients. Saudi J Kidney Dis Transpl 2017;28:183-5

How to cite this URL:
Gunawardena KW, Wijewickrama ES, Carukshi A, Lanerolle RD. Prevalence of dyslipidemia and macrovascular complications among post kidney transplant patients. Saudi J Kidney Dis Transpl [serial online] 2017 [cited 2017 Aug 24];28:183-5. Available from: http://www.sjkdt.org/text.asp?2017/28/1/183/198273
To the Editor,

Derangements in lipid profile usually occur beyond Stage 3 chronic kidney disease,[1] and immunosuppressive drugs (glucocorticoids and calcineurin inhibitors) contribute to hypercholesterolemia and hypertriglyceridemia after kidney transplantation.[2] Dyslipidemia is common among transplanted patients, and it plays a role in the inferior survival of the graft as well as the patient.[3]

Despite significant improvement in graft survival in the recent past,[4] recipient survival is low compared to the normal population[5] with most mortality being related to macrovascular disease in post kidney transplant patients.[6] Only a few studies exist on this topic in Sri Lankan kidney transplant population.[7] We undertook this study to assess the prevalence of dyslipidemia and macrovascular complications among the post kidney transplant patients population and to assess the contribution of dyslipidemia to macrovascular complications. A retrospective cross-sectional study was conducted among post kidney transplant patients from the University Professorial Unit clinic over a six-month period. Demographic details were taken through an intervieweradministered questionnaire. Total cholesterol (TC) level (within last 1 year), whether the patient was diagnosed with hypertension and history of macrovascular complications were documented from existing clinic records. If TC value within the stipulated time period was not available, it was performed with the consent of the patient. All investigations were done at Renal Research Laboratory, Faculty of Medicine, Colombo.

Data were analyzed with Statistical Package for the Social Sciences (SPSS) software version 17.0 (SPSS Inc., Chicago, IL, USA). All associations were assessed at a 95% confidence interval. Both the Fisher's exact and Chi-square tests were calculated to minimize the error that could occur due to the relatively small study population. Ethical clearance for this study had been obtained from the Ethical Review Committee, Faculty of Medicine, University of Colombo.

There were 195 patients in the study. One hundred and twenty-eight (65.6%) participants were males. Mean age was 45.56 (standard deviation = 11.609) years in the study population. TC was available in 115 patients. Among them, 43 (37.4%) had TC >200. Ten had pretransplant DM and eight had new onset DM after transplant. A TC >200 was seen in 40% of those with pretransplant diabetes mellitus and 22.2% of those with new onset diabetes mellitus after transplant. One hundred and seventy-four (89.23%) patients were found be hypertensive.

[Table 1] illustrates the prevalence of macrovascular complications in the study population, and [Table 2] shows the association between having a TC >200 and development of macrovascular diseases.
Table 1. Prevalence of macrovascular complications (n=195).

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Table 2. Association between having TC (>200) and development of macrovascular complications (n=115).

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A high TC value (TC >200) is seen commonly among the post kidney transplant patient population. It is more common in patients with pretransplant diabetes mellitus than those with new onset diabetes mellitus after transplant. This could be explained by the longer duration of exposure to diabetes mellitus in patients with pretransplant diabetes mellitus.

Prevalence of macrovascular complications was relatively low in the population studied. There was no statistically significant association between having a high TC value and development of transient ischemic attacks or stroke.

Paradoxically, high TC level was found to be protective against ischemic heart disease and peripheral vascular disease. This could be explained by the fact that we have considered the TC level within the past one year, and patients with macrovascular complications may have already received lipid-lowering agents.

High TC level and hypertension were common among the post kidney transplant population studied. The high prevalence of hypertension seen in this population is not surprising as it could have been contributed to by the chronic kidney disease itself and the immunosuppressants such as steroids.

The limitations to this study are that the study population was relatively small. We have assessed the association between total cholesterol level within last one year with a history of development of macrovascular complications where an error could occur. If patient had developed macrovascular complications in the past and they were detected to have high TC they would have been treated. These patients would have been missed in a recent TC screen.

Conflict of interest: None declared.

 
   References Top

1.
Taal Taal MW, Chertow GM, Marsden PA, et al. The consequences of advanced kidney disease. Kidney 2012;2:2066-7.  Back to cited text no. 1
    
2.
Kasiske B, Cosio FG, Beto J, et al. Clinical practice guidelines for managing dyslipidemias in kidney transplant patients: A report from the Managing Dyslipidemias in Chronic Kidney Disease Work Group of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Am J Transplant 2004;4 Suppl 7:13- 53.  Back to cited text no. 2
    
3.
Wanner C, Quaschning T, Weingärnter K. Impact of dyslipidaemia in renal transplant recipients. Curr Opin Urol 2000;10:77-80.  Back to cited text no. 3
    
4.
Hariharan S, Johnson CP, Bresnahan BA, Taranto SE, McIntosh MJ, Stablein D. Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med 2000;342:605-12.  Back to cited text no. 4
    
5.
Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998; 32 5 Suppl 3:S112-9.  Back to cited text no. 5
    
6.
Levey AS, Beto JA, Coronado BE, et al. Controlling the epidemic of cardiovascular disease in chronic renal disease: What do we know? What do we need to learn? Where do we go from here? National Kidney Foundation Task Force on Cardiovascular Disease. Am J Kidney Dis 1998;32:853-906.  Back to cited text no. 6
    
7.
Lanerolle RL, Fernando DJ, Sheriff MH. Macrovascular disease in Sri Lankan kidney transplant recipients. Ceylon Med J 1997;42: 78-80.  Back to cited text no. 7
    

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Correspondence Address:
Rushika D Lanerolle
Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo
Sri Lanka
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DOI: 10.4103/1319-2442.198273

PMID: 28098125

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