Sains Malaysiana 47(1)(2018): 149–155
http://dx.doi.org/10.17576/jsm-2018-4701-18
Evaluating Cardiovascular Risk in Chronic Kidney
Disease Patients: A Biomarker Approach
(Menilai Risiko Kardiovaskular pada Pesakit Buah
Pinggang Kronik: Pendekatan Penanda Biologi)
ABDUL HALIM ABDUL GAFOR*, ROZITA MOHD, RIZNA CADER, KONG WEI YEN, MARLYN MOHAMAD, SHAMSUL AZHAR SHAH, ARBAIYAH BAIN
& NORELLA CT KONG
Faculty of Medicine, Universiti Kebangsaan
Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur,
Wilayah Persekutuan, Malaysia
Diserahkan: 14 Jun 2016/Diterima: 16 Jun 2017
ABSTRACT
Cardiovascular disease (CVD) is a major cause of
morbidity and mortality in chronic kidney disease (CKD)
patients. This study aimed to determine the roles of CVD biomarkers
in CKD patients. This was a case-control study which
recruited consecutive patients with stage 2-4 CKD patients
with and without CVD. Serum levels of highly-sensitive
C reactive protein (hs-CRP), cystatin C (CysC), asymmetrical
dimetylarginine (ADMA) and symmetrical dimethylarginine
(SDMA)
were measured. Sixty two stage 2-4 CKD patients with a mean age of
60.3 ± 10.4 years were recruited. Twenty three (37.1%) of them had CVD.
Those CKD patients with CVD were older (64.1±8.0 vs 58.1± 1.1, p<0.05) and had
significantly higher systolic blood pressure (139.4 ± 16.2 vs 129.4 ± 14.8
mmHg, p<0.05). Diabetic patients had 8 times (95% CI 1.25-51.77, p< 0.05) higher risk to develop CVD. CKD patients
with CVD had a higher serum creatinine (185.0 ± 54.1 vs 154.1
± 54.4 μmol/L, p<0.05), a lower estimated glomerular filtration
rate (33.7 ± 12.2 vs 42.2 ± 14.5 mL/min/1.73m2 p<0.05)
and a lower triglyceride levels (1.3 (1.1-1.7) vs 1.8 (1.4-2.3) mmol/L, p<0.05),
compared to those without CVD. Fasting blood sugar was 7.1 ± 2.7
mmol/L in CVD group and 6.3 ± 1.6 mmol/L in non CVD group
(p>0.05). There were no differences in their mean serum levels of hs-CRP,
CysC, ADMA and SDMA. Risk factors including
age, diabetes mellitus, hypertension and renal functions were still the most
important CVD risk factors in CKD patients.
Keywords: Asymmetrical dimetylarginine; biomarker; cardiovascular
disease; chronic kidney disease; cystatin C
ABSTRAK
Penyakit kardiovaskular (CVD) adalah punca utama morbiditi
dan kematian kepada pesakit buah pinggang kronik (CKD).
Kajian ini bertujuan untuk menentukan peranan penanda biologi kardiovaskular
dalam kalangan pesakit CKD. Ini adalah satu kajian kes-kawalan
yang melibatkan pesakit CKD peringkat 2-4 dengan dan tanpa
CVD. Tahap serum protein reaktif C sensitif berdaya tinggi
(hs-CRP), sistatin C (CysC), asimetri dimetilarginin (ADMA)
dan simetri dimetilarginin (SDMA) diukur. Enam puluh dua pesakit
CKD peringkat 2-4 dengan purata umur 60.3 ± 10.4
tahun telah diambil. Dua puluh tiga (37.1%) daripada mereka mempunyai
CVD.
Pesakit CKD dengan CVD yang lebih tua (64.1 ±
8.0 berbanding 58.1 ± 1.1, p<0.05)
dan mempunyai tekanan darah sistolik yang lebih tinggi (139.4 ±
16.2 berbanding 129.4 ± 14.8 mmHg, p<0.05). Seperti
yang dijangka pesakit kencing manis mempunyai 8 kali (95% CI 1.25-51.77,
p<0.05) risiko yang lebih tinggi untuk mendapat CVD. Pesakit CKD dengan
CVD
mempunyai nilai serum kreatinin yang lebih tinggi
(185.0 ± 54.1 berbanding 154.1 ± 54.4 μmol/L,
p<0.05 lebih rendah anggaran kadar penapisan glomerul
(33.7 ± 12.2 berbanding 42.2 ± 14.5 mL/min/1.73 m2,
p<0.05 dan tahap trigliserida yang lebih rendah (1.3 (1.1-1.7)
berbanding 1.8 (1.4-2.3) mmol/L, p<0.05) berbanding dengan
mereka yang tidak mempunyai CVD. Paras gula berpuasa adalah 6.8 ±
2.5 mmol/L di dalam kumpulan CVD dan 7.0 ± 2.9 mmol/L
dalam kumpulan bukan CVD (p>0.05). Tidak ada perbezaan
dalam tahap serum hs-CRP, CycC, ADMA dan
SDMA
mereka. Kesimpulan daripada kajian ini adalah faktor
risiko CVD
tradisi seperti umur, penyakit kencing manis, darah
tinggi dan fungsi buah pinggang masih adalah faktor risiko CVD yang paling penting dalam pesakit
CKD.
Kata kunci: Asimetri
dimetilarginin; sistatin C; penanda biologi; penyakit buah pinggang kronik;
penyakit kardiovaskular
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*Pengarang untuk surat-menyurat; email; halimgafor@gmail.com
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