RENAL TRANSPLANT RECIPIENTS

PATTERN OF LIPID ABNORMALITIES AND THEIR RELATIONSHIP TO HBA1C

Abstract

Introduction: Good glycemic control and lipid modification are potentially
important intervention for improving outcome after kidney transplantation. Objective: To
determine the frequency of dyslipidemia and its types in renal transplant recipients (RTRs),
and to observe impact of hyperglycemia on their lipid profile. Design: Case control study.
Period: June 2011 to May 2012. Setting: Kidney Dialysis Department of Jinnah Hospital
Lahore, Urology Department of Mayo Hospital Lahore and Pathology Department Allama
Iqbal Medical College Lahore. Patients and Methods: A total of 40 RTR were included in the
study. An equal number of sex and age matched healthy subjects were considered as control
group. The patients were on regular post transplant follow up in Kidney Dialysis Department of
Jinnah Hospital Lahore and Urology Department of Mayo Hospital Lahore and had no clinical
or laboratory evidence of graft rejection, post-transplant diabetes mellitus, hypertension or inter
current infection. Total cholesterol (TC), triglyceride (TG), High density Lipoprotein-Cholesterol
(HDL-C), and Glycohemoglobin A1c (HbA1c) were estimated in all subjects. These subjects
were divided into Diabetic and non-diabetic groups, according to level of HbA1c. Results:
The mean age of the RTR was 34.5± 9.02 years and the mean duration of transplant was
36.70 ± 38.07 months. RTRs showed significantly high mean levels of TG (p< 0.002), TC (p<
0.00), LDL-C (p< 0.01), and HDL-C (p< 0.05) as compared to the control subjects. Elevated
TC, TG, LDL-C and low HDL was observed in 32.5%, 72.5%, 52.5%, and 60% of total RTR,
respectively. The mean levels of TC, TG and HDL-C were increased in Diabetic transplant group
as compared to non-diabetic RTR. Percentage of elevated TC, TG, LDL-C and decreased HDL
in diabetic group of RTR versus non diabetic RTR was 43.7% Vs 25% , 81.2% Vs 66.6%, , 62.5%
Vs 44.4%, and 50% Vs 66.6% respectively. There was a positive relationship between HbA1c
and lipid profile (TC, TG, and LDL – C) in both Diabetic and Non Diabetic Group. A statistically
significant correlation of the mean HbA1c levels with TG level was observed in Diabetic RTR.
Conclusion: Dyslipidemia in our RTRs was observed as elevated levels of TC, TG and LDL-C. In
diabetic RTR, a statistically significant positive correlation of the HbA1c levels with TG level was
observed. More rigorous glycemic control and lipid modification will reduce the development of
microvascular complications.