EFFECTS OF STATINS IN THE TREATEMENT OF UREMIC DYSLIPIDEMIA

Muhamedin Rushiti, Teuta Emini, Blerim Rustemi

Abstract

Cardiovascular disease further remains as the main cause of mortality in patients with kidney diseases . Uremic dysfunction and apolipoprotein metabolism disorders are counted as a wellknown risk factor of cardiovascular disease (CVD) in patients with chronic kidney disease. A large number of studies have reported significant results of studies on the effects of hypolipemic drugs in the treatment of uremic dyslipidemia, a group of scientists reported positive effects while the other group is the opposite, the role of hypolipemic therapy in HD treated uremic patients is controversial and still remains confusing, wider and larger patient studies are needed to document the positive effects of statins on the treatment of uremic dyslipidemia. Numerous epidemiological studies have verified a high correlation between high LDL-ch and TG serum levels and lower proloquent HDL-ch cholesterol and high risk incidence of cardiovascular disease in predial and uremic patients treated with HD. Otherwise the role of dyslipidemia in the pathophysiology of atherosclerotic diseases in patients with damage kidney function remains still controversial. Some studies have shown a positive relations between cholesterol values ??and risk of disease in patients with ESRD, while others failed to find any significant correlation. Finally, several studies suggested a reverse relations between serum cholesterol values ??and mortality in patients with ESRD patients. Low-Density Cholesterol (LDL-ch), High-Density Cholesterol (HDL-ch) and plasma Triglyceride concentration were determined in patients with ESRD treated by chronically repeated hemodialysis=No-80 befrore and treatment of 3 months with 20 mg statins (once daily, after dinner). In addition, the plasma activity of enzymes (Aspartat Aminotransferasae-AST,Alanin Aminotransferasae-ALT, CPK, CK-MB, Alkaline Phosphatasae ( AP), Lactat Dehidrogenasae (LDH), possibly involved as a markers of hepatic or muscle toxicity were detected as well. Results shows that the Low Densitty Choleste-rol (LDL-ch) and TG concentrations were significantly higher in patients with ESRD submitted to chronic Haemodialysis ( HD) than in control subjects matched by gender and age: p< 0.005. The High-Density Cholesterol (HDL-ch) concentration, before treatment with statins in investigated patients, was a near the normal value-1.20±0.30 mmol/l for men and 1.30±0.50 mmol/l for women, referent values in a controls: 1.65±0.60 mmol/l. The terapy with statins was effective concerning the LDL-ch and TG and theirs concentration were significantly diminished: p <0.005-0.0001. The HDL-ch concentration after statins treatment was a just higher than the pretreatment values ( 1.40 ±0.60 for men and and- 1.35±0.40 mmol/l for women) but without statistical significance :p < 0.26-0.75. The activity of tested hepatic and muscle enzymes (AP, AST, ALT, CPK, CK-MB ) before and treatment with statins in same group of dialyzed patients was statistically lower after therapy: 159.40 ±25.20 vs130.50 ±37.40 U/l, p<0.02 for men , and 162.10 ±32.60vs135.40 ±36.40 U/l, p<0.005 for women. Having in mind the newly accepted theories for accelerated atherosclerosis in patients with ESRD treated with HD, the medical control of lipid profile rise considerably important.

Pages: 97 - 102