Could Complete Blood Count Parameters and Non-fasting Cholesterol Profile Describe Inflammation and Oxidative Stress in Chronic Kidney Disease?

Ika Nindya Kadariswantiningsih, Mochammad Thaha, Cahyo Wibisono Nugroho, Berliana Hamidah, Haerani Rasyid, Zaky El Hakim, Maulana Muhtadin Suryansyah, Mohammad Yusuf Alsagaff, Djoko Santoso, Maulana Antiyan Empitu, Yusuke Suzuki

Abstract


BACKGROUND: Establishment of inexpensive clinical laboratory tests to evaluate inflammation and oxidative stress is urgently needed in the limited resources settings. This study aims to investigate the potential of complete blood count (CBC) parameters and non-fasting cholesterol profile parameters to describe inflammation and oxidative stress in chronic kidney disease (CKD) patients.

METHODS: Measurement of CBC, non-fasting cholesterol profile, high sensitivity C-reactive protein (hs-CRP) and malondialdehyde (MDA) were performed in 71 CKD patients grouped into hemodialysis (HD) and non-hemodialysis (non-HD). Correlation analysis were performed to assess the potential of CBC and cholesterol profile to describe the level of hs-CRP and MDA.

RESULTS: In the HD group, total cholesterol was moderately associated with hs-CRP while total cholesterol/HDL-C ratio, monocyte/HDL-C ratio, monocyte/LDL-C ratio, neutrophil/HDL-C ratio, neutrophil/LDL-C ratio, platelet/HDL-C ratio and platelet/LDL-C ratio were strongly associated with hs-CRP. In the non-HD group,
only neutrophil/total cholesterol ratio and platelet/total cholesterol ratio that were associated with hs-CRP. Total cholesterol, monocyte/LDL-C ratio, neutrophil/LDL-C ratio and platelet/LDL-C ratio were moderately associated with MDA while total cholesterol/HDL-C ratio, monocyte/HDL-C ratio, neutrophil/HDL-C ratio and platelet/HDL-C ratio were strongly associated respectively with MDA in HD group. In the non-HD group, total cholesterol/HDL-C ratio, neutrophil/HDL-C ratio and platelet/HDL-C ratio were moderately associated with MDA in non-HD group while monocyte/HDL-C ratio was weakly associated with MDA.

CONCLUSION: Some CBC parameters and non-fasting cholesterol profile such as cholesterol/HDL-C, monocyte/HDL-C, neutrophil/HDL-C and platelet/HDL-C ratio showed a potential to describe the inflammation and stress oxidative markers, given some strong associations with the level of hs-CRP and MDA. Further study is needed to assess whether this parameter represent long-term prognostic value among CKD patients.

KEYWORDS: inflammation, oxidative stress, CRP, MDA, TAC, 8-OHdG, CBC, cholesterol


Full Text:

PDF

References


Cheung AK, Sarnak MJ, Yan G, Dwyer JT, Heyka RJ, Rocco M V, et al. Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients. Kidney Int. 2000; 58: 353-62, CrossRef.

Schiffrin EL, Lipman ML, Mann JFE. Chronic kidney disease: effects on the cardiovascular system. Circulation. 2007; 116: 85-97, CrossRef.

Stenvinkel P, Gillespie IA, Tunks J, Addison J, Kronenberg F, Drueke TB, et al. Inflammation modifies the paradoxical association between body mass index and mortality in hemodialysis patients. J Am Soc Nephrol. 2016; 27: 1479-86, CrossRef.

Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO, Criqui M, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003; 107: 499-511, CrossRef.

Atamer A, Kocyigit Y, Ecder SA, Selek S, Ilhan N, Ecder T, et al. Effect of oxidative stress on antioxidant enzyme activities, homocysteine and lipoproteins in chronic kidney disease. J Nephrol. 2008; 21: 924-30, PMID.

Stanifer JW, Muiru A, Jafar TH, Patel UD. Chronic kidney disease in low-and middle-income countries. Nephrol Dial Transplant. 2016; 31: 868-74, CrossRef.

Guthrie GJK, Charles KA, Roxburgh CSD, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil–lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol. 2013; 88: 218-30, CrossRef.

Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med. 2012; 5: 2, CrossRef.

Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB. Designing clinical research. Philadelphia: Lippincott Williams & Wilkins; 2011.

Yilmaz G, Sevinc C, Ustundag S, Yavuz YC, Hacıbekiroglu T, Hatipoglu E, et al. The relationship between mean platelet volume and neutrophil/lymphocyte ratio with inflammation and proteinuria in chronic kidney disease. Saudi J Kidney Dis Transplant. 2017; 28: 90-4, CrossRef.

Inker LA, Astor BC, Fox CH, Isakova T, Lash JP, Peralta CA, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. 2014; 63: 713-35, CrossRef.

Keddis MT, Amer H, Voskoboev N, Kremers WK, Rule AD, Lieske JC. Creatinine-based and cystatin C-based GFR estimating equations and their non-GFR determinants in kidney transplant recipients. Clin J Am Soc Nephrol. 2016; 11: 1640-9, CrossRef.

Remuzzi G, Benigni A, Remuzzi A. Mechanisms of progression and regression of renal lesions of chronic nephropathies and diabetes. J Clin Invest. 2006; 116: 288-96, CrossRef.

Xu G, Luo K, Liu H, Huang T, Fang X, Tu W. The progress of inflammation and oxidative stress in patients with chronic kidney disease. Ren Fail. 2015; 37: 45-9, CrossRef.

Welsh P, Preiss D, Tsiropoulou S, Rios FJ, Harvey A, Dulak-Lis MG, et al. Biomarkers of vascular inflammation and cardiovascular disease. In: Berbari A, Mancia G, editors. Arterial Disorders. Berlin: Springer; 2015. p. 115-36, CrossRef.

Malhotra R, Marcelli D, von Gersdorff G, Grassmann A, Schaller M, Bayh I, et al. Relationship of neutrophil-to-lymphocyte ratio and serum albumin levels with C-reactive protein in hemodialysis patients: results from 2 international cohort studies. Nephron. 2015; 130: 263-70, CrossRef.

Okyay GU, İnal S, Öneç K, Er RE, Paşaoğlu Ö, Paşaoğlu H, et al. Neutrophil to lymphocyte ratio in evaluation of inflammation in patients with chronic kidney disease. Ren Fail. 2013; 35: 29-36, CrossRef.

Turkmen K. Platelet-to-lymphocyte ratio: one of the novel and valuable platelet indices in hemodialysis patients. Hemodial Int. 2013; 17: 670, CrossRef.

Nordestgaard BG, Langsted A, Mora S, Kolovou G, Baum H, Bruckert E, et al. Fasting is not routinely required for determination of a lipid profile: clinical and laboratory implications including flagging at desirable concentration cut-points—a joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine. Eur Heart J. 2016; 37: 1944-58, CrossRef.

Schnabel E, Anderson JM, Farquhar MG. The tight junction protein ZO-1 is concentrated along slit diaphragms of the glomerular epithelium. J Cell Biol. 1990; 111: 1255-63, CrossRef.

Waters DD, Boekholdt SM. An evidence-based guide to cholesterollowering guidelines. Can J Cardiol. 2017; 33: 343-9, CrossRef.

Langsted A, Freiberg JJ, Nordestgaard BG. Fasting and nonfasting lipid levels: influence of normal food intake on lipids, lipoproteins, apolipoproteins, and cardiovascular risk prediction. Circulation. 2008; 118: 2047-56, CrossRef.

Langsted A, Nordestgaard BG. Nonfasting lipids, lipoproteins, and apolipoproteins in individuals with and without diabetes: 58 434 individuals from the Copenhagen General Population Study. Clin Chem. 2011; 57: 482-9, CrossRef.

Dounousi E, Papavasiliou E, Makedou A, Ioannou K, Katopodis KP, Tselepis A, et al. Oxidative stress is progressively enhanced with advancing stages of CKD. Am J Kidney Dis. 2006; 48: 752-60, CrossRef.

Landray MJ, Wheeler DC, Lip GYH, Newman DJ, Blann AD, McGlynn FJ, et al. Inflammation, endothelial dysfunction, and platelet activation in patients with chronic kidney disease: the chronic renal impairment in Birmingham (CRIB) study. Am J kidney Dis. 2004; 43: 244-53, CrossRef.

Yang J, Zhang L, Yu C, Yang X-F, Wang H. Monocyte and macrophage differentiation: circulation inflammatory monocyte as biomarker for inflammatory diseases. Biomark Res. 2014; 2: 1, CrossRef.

Vaziri ND, Navab M, Fogelman AM. HDL metabolism and activity in chronic kidney disease. Nat Rev Nephrol. 2010; 6: 287-96, CrossRef.

Thaha M, Yusuf M, Empitu MA, Bakarman A, Tomino Y. Distribution of dimethylarginine-dimethylaminohydrolase-II (DDAH2) gene polymorphism in hemodialysis patients. Acta Med Indones. 2013; 45: 83-8, PMID.

Thaha M, Empitu MA, Kadariswantiningsih IN, Nugroho CW, Hasanatuludhhiyah N, Rasyid H, et al. Anthropometry-based Body Fat Percentage Predicts High hs-CRP in Chronic Kidney Disease Patients. Indones Biomed J. 2018; 10: 184-91, CrossRef.




DOI: https://doi.org/10.18585/inabj.v10i3.451

Indexed by:

                 

                  

               

     

 

The Prodia Education and Research Institute