Screening of Thyroid Dysfunction and Dyslipidaemia in Patients of Diabetic Nephropathy in a Tertiary Care Centre in Western U.P
Background: Diabetes mellitus is often associated with multiple organ co-morbidities, including thyroid dysfunction. This has been associated with poorer prognosis, particularly in patients with end-stage renal disease. Hypothyroidism enhances the progression of atherogenesis. CRF is a serious health problem in worldwide. In developing nation, cardiovascular disease (CVD) is the leading cause of mortality in chronic kidney disease (CRF) patients. Therefore, early determination and management of the risk factors for CVD in D.M patients play an important role to develop more effective screening and treatment strategies
Methods: .M, Thyroid status, Lipid profile, serum Urea, serum Creatinine, serum Uric acid, serum electrolyte, Catalase, and Superoxide dismutase (SOD) were assayed in 160 subjects in which 80 patients of D.M were having hypertension and 80 healthy controls.
Results: There was found significantly increased level (p<0.001) of TSH in D.M associated with hypertension patients. We also found deranged lipid profile and renal functions in D.M patients associated with hypertension as compared to controls.
Conclusions: In our present study, we arrived at conclusion that dyslipidemia and thyroid dysfunction is very common in D.M patients. Our study revealed that there was significant association between thyroid dysfunction, D.M and dyslipidemia.
2. Rajagopalan B, Dolia PB, Arumalla VK. Renal function markers and thyroid hormone status in undialyzed chronic kidney disease. Al Ameen J Med Sci 2013;6(1):70–4.
3. Chonchol M, Lippi G, Salvagno G, Zoppini G, Muggeo M, Targher G. Prevalence of subclinical hypothyroidism in patients with chronic kidney disease. Clin J Am SocNephrol 2008;3(5)
4. Thomas R, Kanso A, Sedor JR. Chronic kidney disease and its complications. Prim Care 2008; 35(2):329–44.
5. Malyszko J, Malyszko J, Wolczynski S, Mysliwiec M. Adiponectin, leptin and thyroid hormones in patients with chronic renal failure and on renal replacement therapy: are they related? Nephrol Dial Transplant 2006;21(1):145–52.
6. Chen SC, Hung CC,Kuo MC, Lee JJ, Chiu YW, et al.Association of dyslipidemia with renal outcomes in chronic kidney disease. PLoSOne 2013;8(2):e55643.
7. Lewington S, Whitlock G, Clarke R, Sherliker P, et al. Blood cholesterol and vascular mortality by age, sex, and blood pressure: A meta‑analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet 2007;370:1829‑39.
8. Attman PO, Samuelsson O. Dyslipidemia of kidney disease. CurrOpinLipidol 2009;20:293‑9.
9. Kwan BC, Kronenberg F, Beddhu S, Cheung AK. Lipoprotein metabolism and lipid management in chronic kidney disease. J Am SocNephrol 2007;18:1246‑61.
10. Rao Mv, Qiu Y, Wang C, Bakris G. Hypertension and CKD: Kidney Early Evaluation Program (Keep) and National Health and Nutrition Examination Survey (NHANES), 1999-2004. Am J Kidney Dis. 2008;51(Suppl 2):S30-S37.
11. Ashizawa K, Imaizumi M, Usa T, Tominaga T, Sera N, Hida A, et al.Metabolic cardiovascular disease risk factors and their clustering in subclinical hypothyroidism. ClinEndocrinol (Oxf) 2010;72(5):689–95.
12. Chobanian Av, BakrisGl, Black Hr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The Jnc 7 Report. JAMA. 2003; 289:2560-2572.
13. Evans JL, Goldfine ID, Maddux BA, Grodsky GM. Oxidative stress and stress‑activated signaling pathways: A unifying hypothesis of type 2 diabetes. Endocr Rev 2002;23:599‑622.
14. Lo JC, Chertow GM, Go AS, Hsu CY. Increased prevalence of subclinical and clinical hypothyroidism in persons with chronic kidney disease. Kidney Int 2005;67(3):1047–52.
15. Collaboration PS, Lewington S, Whitlock G, Clarke R, Sherlinker P, Emberson J, Halsey J, et al.Blood cholesterol and vascular mortality by age, sex and blood pressure a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet 2007;370(9602):1829–39.
16. Marklund S. and Marklund G. Involvement of the superoxide anion radical in the autoxidation of pyrogallol and a convenient assay for superoxide dismutase. Eur. J. Biochem 1974; 47:469-474.
17. Aebi H. Catalase in Vitro. Methods Enzymol 1984; 105:121-126. Rajeev G, ChickballapurRayappa WD, Vijayalakshmi R, Swathi M, Kumar S. Evaluation of thyroid hormone levels in chronic kidney disease patients. Saudi J Kidney Dis Transpl 2015;26(1):90–3. 22.
18. Sinha V, Kumar A, Kachhawa P, et al. Thyroid dysfunction and dyslipidemia in patients with chronic kidney diseases. International journal of medical sciences and public health 2016;5(12):1-7.
19. Paudel K. Prevalence and clinical characteristics of hypothyroidism in a population undergoing maintenance hemodialysis. J ClinDiagn Res 2014; 8(4):MC01–4.
20. Kachhawa K, Varma M, Kachhawa P, et al. Study of dyslipidemia and cystatin C levels as a predictive marker of CKD in type 2 diabetes mellitus patients at a teaching hospital in central India. J InteNephAndro 2016:3(1):24-28.
21. Shantha GPS, Kumar AA, Bhise V, Khanna R, Sivagnanam K, Subramanian KK. Prevalence of subclinical hypothyroidism in patients with end-stage renal disease and the role of serum albumin: a cross-sectional study from South India. Cardiorenal Med 2011;1(4):255–60.
22. Magil AB. Interstitial foam cells and oxidized lipoprotein in human glomerular disease. Mod Pathol 1999;12:33‑40.
23. Li W, Wang G, Lu X, Jiang Y, Xu L, Zhao X. Lycopene ameliorates renal function in rats with streptozotocin‑induced diabetes. Int J ClinExpPathol 2014;7:5008‑15.
24. Koch M, Kutkuhn B, Trenkwalder E, Bach D, Grabensee B, Dieplinger H, et al. Apolipoprotein B, fibrinogen, HDL cholesterol, and apolipoprotein (a) phenotypes predict coronary artery disease in hemodialysis patients. J Am SocNephrol 1997;8:1889‑98.
25. Shlipak MG, Fried LF, Cushman M, Manolio TA, Peterson D, Stehman‑Breen C, et al. Cardiovascular mortality risk in chronic kidney disease: Comparison of traditional and novel risk factors. JAMA 2005;293:1737‑45.
26. Kachhawa K, Varma M, Kachhawa P, et al. Study of dyslipidemia and antioxidant status in chronic kidney diseases patients at a hospital in South East Asia. J Health Res Rev 2016;3(1):28-30.
27. Kimura H, Miyazaki R, Imura T, Masunaga S, Suzuki S, Gejyo F, et al. Hepatic lipase mutation may reduce vascular disease prevalence in hemodialysis patients with high CETP levels. Kidney Int 2003;64:1829‑37.
28. Lassègue B, Griendling K. Reactive oxygen species in hypertension. An Update Am J Hypertens 2004; 17:852–860.
29. Ashizawa K, Imaizumi M, Usa T, Tominaga T, Sera N, Hida A, et al.Metabolic cardiovascular disease risk factors and their clustering in subclinical hypothyroidism. ClinEndocrinol (Oxf) 2010;72(5):689–95.
30. Basu G, Mohapatra A. Interactions between thyroid disorders and kidney disease. Indian J EndocrinolMetab 2012;16(2):204–13.
31. Tsimihodimos V, Mitrogianni Z, Elisaf M. Dyslipidemia associated with chronic kidney disease. Open Cardiovasc Med J 2011;5:41–8.Inker . Rafat D, Rabbani T, Ahmad J, Ansari M.
32 Influence of iron metabolism indices on HbA1c in non-diabetic pregnant women with and without iron-deficiency anaemia: effect of iron supplementation. Endocrine Abstracts. 2012;29:550.
33 Hardikar PS, Joshi SM, Bhat DS, Raut DA, Katre PA, Lubree HG, et al. Spuriously high prevalence of prediabetes diagnosed by HbA (1c) in young indians partly explained by hematological factors and iron deficiency anaemia. Diabetes Care. 2012;35:797–802.
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