Lipid ratios, atherogenic coefficient and atherogenic index of plasma as parameters in assessing cardiovascular risk in type 2 diabetes mellitus

Background:Cardiovascular disease (CVD) is responsible for morbidity and mortality in type 2 diabetes mellitus (T2DM) patients. Diabetes alters the utilization of lipids and lipoproteins which lead to diabetes induced atherogenic dyslipidemia, one of the most important risk factor for the development of atherosclerosis. The relationship between elevation of serum lipids and vascular complications of diabetes has long been of interest. The use of LDL-c alone for assessment of cardiovascular risk would ignore the TG-rich lipoproteins. Lipid ratios, atherogenic coefficient and atherogenic index of plasma have been found to indicate an atherogenic risk and are better predictors of cardiovascular risk than lipids alone. Hence the present study is taken up to evaluate the lipid ratios, atherogenic coefficient, atherogenic index of plasma in assessing the CV risk in type 2 diabetes mellitus.Methods: This case-control prospective study included three groups. (Group 1: control, group II: T2DM without complications, group III: T2DM with complications, n=25). Total cholesterol, triglycerides and HDL-c were analysed using commercially available kits on spectrophotometer. Nitric oxide was estimated spectrophotometrically by Griess method. VLDL, LDL, Lipid ratios, non-HDL cholesterol, AC and AIP were calculated in all the three groups. Statistical analysis was performed using SPSS version 22.0.Results: All of the atherogenic indices were found to be significantly different upon comparing these indices in both patients and control groups.Conclusions: The ratios contribute significantly to the estimation of CVD risk  in type 2 diabetes mellitus especially, when the absolute values of lipid profile seem normal or not markedly deranged or in centres with insufficient resources.

PILL BURDEN, DRUG CLASS DISTRIBUTION AND FINANCIAL BURDEN FOR BUYING MEDICINES IN DIFFERENT MODALITIES OF CHRONIC KIDNEY DISEASE PATIENTS: CROSS-SECTIONAL STUDY

Objective: The objective of the study was to assess the pill burden (PB), drug class distribution and financial burden for buying medicines in different treatment modalities of chronic kidney disease (CKD) patients. Methods: A prospective, cross-sectional study was performed in 244 CKD patients and they were divided into 4 groups as follows: pre-dialysis patients (stages 1-5) as group 1, hemodialysis (HD) patients as group 2, peritoneal dialysis (PD) patients as group 3 and renal transplant recipient (RTR) patients as group 4. Data was collected in pre-designed form through direct patient interaction.Results: Out of 244 CKD patients, PB considering the total number of pills/d in different modalities is 12±5 in pre-dialysis, 10±3 in HD, 13±5 in PD, 14±7 in RTR and for the number of drug classes/d in different modalities is 7±3 in pre-dialysis, 7±2 in HD, 8±3 in PD and 9±3 in RTR. On average mean PB in a number of pills/d is 12±5 and number of drug classes/d is 8±3. Among all the patients, the RTR individuals are having high medicinal expenditure in comparison to the other modalities.Conclusion: PB for the number of pills/d is highest in RTR and almost similar in different modalities. Great improvement in reducing the PB as well as financial burden directly or indirectly improves the patient compliance as well as the quality of life

Markers of Oxidative Stress, Inflammation, and Endothelial Dysfunction in Diabetic and Nondiabetic Patients with Chronic Kidney Disease on Peritoneal Dialysis

Chronic kidney disease (CKD) is a low-grade inflammatory state which is accom–panied by elevated markers of oxidative stress, inflammatory, and endothelial dysfunction in patients on peritoneal dialysis (PD). These represent a key triad for the development and progression of atherosclerosis. The present study assessed the markers of oxidative stress, inflammatory and endothelial dysfunction in diabetic and non-diabetic CKD patients on PD. A cross-sectional study was undertaken on 100 CKD patients on PD, of whom 52 patients were nondiabetic and 48 were diabetic patients. Blood samples were estimated for malondialdehyde (MDA) and ferric reducing ability of plasma (FRAP) as markers of oxidative stress; interleukin (IL)-6, high-sensitivity C-reactive protein (hs-CRP), and fibrinogen as inflammatory markers; and markers of endothelial dysfunction such as nitric oxide (NO), carotid wall intimal medial thickness (CIMT), and number of plaques, among others. The MDA levels increased and FRAP levels decreased in both diabetic and nondiabetic CKD patients on PD. The levels of IL-6, hs-CRP, fibrinogen, NO, CIMT, and the number of plaques were significantly higher in diabetic patients than in nondiabetic CKD patients on PD. The lipid profile was significantly atherogenic in diabetic patients compared with nondiabetics CKD patients. The results showed increased oxidative stress, inflammation, and endothelial dysfunction in diabetic patients compared with nondiabetics CKD patients on PD

PILL BURDEN, DRUG CLASS DISTRIBUTION AND FINANCIAL BURDEN FOR BUYING MEDICINES IN DIFFERENT MODALITIES OF CHRONIC KIDNEY DISEASE PATIENTS: CROSS-SECTIONAL STUDY

Objective: The objective of the study was to assess the pill burden (PB), drug class distribution and financial burden for buying medicines in different treatment modalities of chronic kidney disease (CKD) patients. Methods: A prospective, cross-sectional study was performed in 244 CKD patients and they were divided into 4 groups as follows: pre-dialysis patients (stages 1-5) as group 1, hemodialysis (HD) patients as group 2, peritoneal dialysis (PD) patients as group 3 and renal transplant recipient (RTR) patients as group 4. Data was collected in pre-designed form through direct patient interaction.Results: Out of 244 CKD patients, PB considering the total number of pills/d in different modalities is 12±5 in pre-dialysis, 10±3 in HD, 13±5 in PD, 14±7 in RTR and for the number of drug classes/d in different modalities is 7±3 in pre-dialysis, 7±2 in HD, 8±3 in PD and 9±3 in RTR. On average mean PB in a number of pills/d is 12±5 and number of drug classes/d is 8±3. Among all the patients, the RTR individuals are having high medicinal expenditure in comparison to the other modalities.Conclusion: PB for the number of pills/d is highest in RTR and almost similar in different modalities. Great improvement in reducing the PB as well as financial burden directly or indirectly improves the patient compliance as well as the quality of life