The evoluation of proxidant and antioxidant parameters to atherosclerosis markers and echocardiographic findings in stage 3-4 chronic kidney disease

IntroductionRisk of CVD has increased in CKD patients. Besides, there has been increased oxidative stress in these patients. In our study, we aimed to investigate oxidative stress state, atherosclerosis development , risk of cardiovascular disease and the relation with oxidative stress parameters and their echocardiographic findings in diabetic and nondiabetic CKD patients of 3-4 phase.Material ? Method90 patients with chronic kidney disease of phase 3-4 applying to Nephrology polyclinic, having routine follow-up and treatment or having medical treatment in Dicle University Faculty of Medicine Research and Application Hospital Nephrology, Endocrinology Clinics between 2009 ? 2010 years were included to this study. 51 were diabetic and 39 were nondiabetic patients. Blood samples of patients were collected for biochemical, hormonal, hematological parameters. Protein and creatinine were measured in the patient?s 24 hour urine. ADMA, MDA, SOD, GSHpx, catalase, vitamin C and E, Paraoxonase and aryl esterase were examined in patients in order to evaluate the oxidative stress. Electrocardiography and echocardiography were applied and blood pressures were measured. Renal USG, right and left CIMT measured in all patients.ResultsIn terms of oxidative stress state, no significant difference between phase 3 and 4 was observed in diabetic (n=51) and nondiabetic (n=39) patients. In diabetic patient group, between CrCl and SOD negative correlation (r= -0.322, p=0.024), between vitamin C and CrCl positive correlation (r=0.305, p=0.029) was observed. No statistically significant relation was observed in CrCl and other parameters. In nondiabetic patient group, no significant relation was observed between CrCl and oxidative stress parameters. In diabetic patient group, CrCl was negatively correlated with LVDd (r= -0.305, p=0.030) and LAD (r=0 -0.329, p=0.018). There is no significant relation between CrCl and other echocardiographic findings. In non diabetic patient group no significant relation was observed between CrCl and echocardiographic findings. In diabetic patient group vitamin E was positively correlated with LVDd (r=0.340, p=0.015) and SOD was positively correlated with LVDs (r=0.309, p=0.032). In nondiabetic patient group, between vitamin C and EF positive correlation (r=0.389, p=0.015), between vitamin C and LVDd negative correlation (r= -0.401, p=0.036), between MDA and LVDs positive correlation (r=0.401, p=0.011) was determined. No significant relation was determined between other oxidative stress parameters and echocardiographic findings. In our study, in diabetic patient group hsCRP was positively correlated with BMI (r=0.500, p<0.001), IVSd (r=0.356, p=0.01), and right CIMT (r=0.359, p=0.01). In diabetic phase 3- 4 CKD patients, IVSd was positively correlated with right CIMT (r=0.303, p=0.031) and left CIMT (r=0.363, p=0.009). In non diabetic patient group EF was negatively correlated with right CIMT (r= -0.468, p=0.003) and left CIMT (r= -0.416, p=0.002). Between left CIMT and IVSd positive correlation (r=0.353, p=0.028), between left CIMT and LAD positive correlation (r=0.502, p=0.001) was determined. Furthermore, between vitamin E and right CIMT (r= -0.336, P=0.037) and left CIMT (r= -0.317, p=0.049) negative correlation was observed.ConclusionIn terms of oxidative stress state, no significant difference between phase 3 and 4 was observed in diabetic and nondiabetic patients. Positive correlation between CrCl and Vitamin C was determined in diabetic patients. In our nondiabetic patient group, no significant relation was determined between CrCl and oxidative stress parameters. In diabetic patient group, negative correlation between CrCl with LAD and LVDd was found. In our diabetic patient group, the inflammation marker hsCRP was positively correlated with IVSd and right CIMT . In diabetic patient group positive correlation was determined between vitamin E and LVDd; and between SOD and LVDs. In nondiabetic patient group between vitamin C and EF positive correlation; between vitamin C and LVDd negative correlation, between MDA and LVDs positive correlation was determined.Keywords: Chronic kidney disease, oxidative stress, echocardiographic parameters, atherosclerosis.