Treatment of Dyslipidemia in Chronic Kidney Disease

Folic acid and melatonin mitigate diabetic nephropathy in rats via inhibition of oxidative stress

Background

Diabetes mellitus is a global epidemic leads to multiple serious health complications, including nephropathy. Diabetic nephropathy is a serious kidney-related complication of type 1 or 2 diabetes that is prevalent in almost 40% of the people with diabetes. We examined whether folic acid and melatonin can reduce progression of nephropathy in rats of type 1 diabetes mellitus by controlling the level of oxidative stress, glucose, lipids, and cytokines.

Methods

Forty-two male albino rats were distributed into six groups, (n = 7 per group). Five of the groups were induced with diabetes by a single intraperitoneal injection of freshly prepared streptozotocin at a dose of 50 mg/kg body weight. After the induction of diabetes, the rats were treated with folic acid (100 mg/kg) and melatonin (10 mg/kg) separately and in combination daily for 6 weeks, whereas, the other diabetic group was treated with glibenclamide (5 mg/kg). One of the diabetic groups served as a positive control. One-way ANOVA was used to compare those five subfields ability followed by LSD multiple comparisons.

Results

The data indicated that diabetes significantly altered the body weight, lipids and kidney function. Diabetic rats exhibited a significant increase in plasma levels of urea, uric acid, creatinine, sodium, tumor necrosis factor alpha (TNF-α), interleukin-6(IL-6), cholesterol, triglycerides, and low-density lipoprotein (LDL). In contrast, plasma total protein, potassium, high-density lipoprotein (HDL) and interleukin-10 (IL-10) decreased significantly in diabetic rats compared to the control rats. Moreover, levels of renal malondialdehyde (MDA) and nitric oxide (NO) were significantly increased while the levels of renal glutathione(GSH), superoxide dismutase(SOD), and catalase (CAT) were significantly decreased in diabetic rats comparison to those in the control rats. Hence, diabetic rats treated with folic acid and melatonin alone as well as in combination showed improvements with respect to the indices in addition to a significant recovery observed via histopathology when compared to the diabetic group.

Conclusions

These results revealed that treatment with folic acid in combination with melatonin in diabetic rats was more effective than treatment with either of folic acid or melatonin alone to alleviate the symptoms of diabetic nephropathy.

Characteristics of the Lipid Profile in Patients with Diabetes Mellitus and Chronic Kidney Disease

Background and aims Diabetes mellitus (DM) is one of the leading causes of end-stage chronic kidney disease (CKD). Patients with DM and CKD have a 10 or even 20 times higher cardiovascular risk (CVR) than the general population. Lipid metabolism disorders are more frequent in these patients, dyslipidemia being aggravated by the presence of hyperglycemia and insulin resistance. The main purpose of our study was to identify possible correlations between lipid profile parameters and altered renal function in patients with DM. We have also analyzed the correlations between lipid parameters, CKD, quality of glycemic control and CVR.

Material and method: The study was performed on 2732 patients with DM which received medical treatment and care at the Center for Diabetes Timisoara, for a 6-month period from March to October 2016, 1508 women (55.2%) and 1224 men (44.8%), mean age 63.7 ± 9.1 (33-78) years and mean diabetes duration 12.4 ± 6.8 (6-33) years. The study group included 312 patients (11.4%) with T1DM and 2420 patients (88.6%) with T2DM.

Results: The prevalence of CKD (GFR< 60 ml/min) was 12.5%. The levels of total cholesterol (TC), triglycerides (TG) and LDLc were significantly higher in the case of patients with DM and CKD (p<0.0001). Patients with CKD had twice the prevalence of ischemic heart disease and cerebrovascular disease when compared to patients without CKD. Peripheral artery disease was present in 16.9% of those with CKD and in 11% of those without CKD. Hypertension (HTN) was present in 91.8% of patients with CKD and in 67.1% of patients without CKD (GFR > 60 ml/min).

Conclusion: Analyzed data showed a strong correlation between CKD, dyslipidemia and CVR in patients with DM. Impaired renal function was strongly correlated with age, duration of DM and weight status of these patients.

Dyslipidemia and the progression of renal disease in chronic renal failure patients

Dyslipidemia is a common complication of progressive kidney disease and contributes to the high cardiovascular morbidity and mortality of chronic kidney disease (CKD) patients. Recent evidence also suggests a role for dyslipidemia in the development and progression of renal disease. Experimental studies have demonstrated that lipids may induce glomerular and tubulointerstitial injury, and that lipid-lowering treatments ameliorate renal injury. Various lipid abnormalities have been associated with the development and progression of renal disease in diabetic and nondiabetic patients. Population-based studies and studies of diabetic patients have reported associations of various lipid abnormalities with the development of renal disease. In patients with CKD, lipid abnormalities have also been associated with renal disease progression. Post hoc analyses of some large clinical trials on patients with vascular disease, diabetes, or dyslipidemia, and a meta-analysis of small, prospective, controlled studies on patients with CKD (diabetics and nondiabetics) suggest that statins may slow the progression of kidney disease. It is unclear whether the beneficial renal effects of statins are due to the reduction of serum cholesterol levels and/or their pleiotropic effects. There is also evidence for synergistic renoprotective effects between statins and renin-angiotensin system inhibitors. According to the results of post hoc analysis of several studies, treatment with fibrates does not seem to confer renoprotection, but evidence is scarce. In summary, there is growing evidence that lipid abnormalities may be a risk factor for renal disease, and that statins appear to confer a renoprotective effect.