Relation of Serum Hypoxanthine as Cardiovascular Risk Factor in Hemodialysis Patients

Abstract

Chronic kidney disease (CKD) is recognized as a health concern globally and leads to high rates of morbidity, mortality and healthcare expenditure. CKD is itself an independent risk factor for unfavorable health outcomes that include CVD. Cardiovascular risk in renal insufficiency is perceived as an important public health problem and preventing and curing cardiovascular complications in patients with renal dysfunction is considered a true priority Prevention and treatment strategies demand precise knowledge of risk factors and of the possibility of modifying them with appropriate treatments. Traditional and non-traditional risk factors for CVD exist in patients with CKD. Traditional factors include smoking, hypertension, dyslipidemia and diabetes which are highly prevalent in CKD patients. Non-traditional risk factors of CKD are mainly uraemia-specific and increase in prevalence as kidney function declines. Some examples of uraemia-specific risk factors that have been well documented include low levels of hemoglobin, albuminuria, and abnormal bone and mineral metabolism. The purine metabolites constitute a major class of uremic toxins. The most important purine metabolites retained in uremia are uric acid UAC, xanthine, HPX, cytidine, and guanosine. Our study sample consisted of 50 patients anuric ESRD on regular HDx thrice sessions per week for 1-5 years duration from NINU(with exclusion criteria diabetic patient, patient have symptoms or signs of inflammation or infection, IHD patient, patient with gout or liver cirrhosis)as a case group & 10 subjects healthy volunteers, as control group. In all subject, we recorded full history, clinical examination, etiology of renal disease and full lab, predialytic serum hypoxanthine level, predialytic serum high sensitive CRP and echocardiography. In the case group; the causes of renal failure were: HTN (40 %), chronic glomerulonephritis (12%), Adult polycystic kidney disease (12%), Unknown cause (10%), Analgesic abuse (10%), Lupus nephritis (6%), Obstructive nephropathy (6%), Reflux nephropathy (2%) and cortical necrosis (2%). Our Laboratory tests in case group revealed that mean Hemoglobin level 10.474 (± 1.3108), mean predialysis Creatinine level 9.292 mg/dl (±2.1052), mean predialysis BUN 87.16 (±16.7007), mean predialysis UAC level 5.668 mg/dl (±1.1138), mean predialysis serum Calcium level level 8.602 mg/dl (±0.7482), mean predialysis serum Phosphorus level 5.598 mg/dl (±1.2869), mean Serum Albumin level 3.884 gm/dl (±0.2895), mean predialysis High sensitive CRP level 89.61 (±9.4033) and mean predialysis HPx level 13.68 (±4.0579).In comparison to control group Hemoglobin level 12.75 (±1.2313), mean Creatinine level 0.93 mg/dl (±0.1337), mean BUN level 15 mg/dl (±3.6515), mean UAC level 4.5 mg/dl (±0.7622), mean serum Calcium level 10.11 mg/dl (±0.802), mean serum Phosphorus level 4.42 mg/dl (±0.6286), mean Serum Albumin level 3.96 gm/dl (±0.4006), mean High sensitive CRP level 54.75 (±18.2365) and mean HPx level 3.2(±1.5492).