Assessment of Cardiovascular Risk in Malnourished Moroccan Haemodialysis Patients: The Interest of Atherogenic Index of Plasma and Lipid Ratios

Abstract

Background: Protein-energy wasting (PEW) and dyslipidaemia are strongly associated with cardiovascular disease (CVD) and accelerated atherosclerosis in end-stage renal diseases patients. Our study aimed to assess the impact of malnutrition on lipid profiles and cardiovascular risk of Moroccan haemodialysis patients using lipid ratios and the atherogenic index of plasma (AIP).Methods and Patients: This cross-sectional study included 126 Moroccan haemodialysis patients aged >18 years who had undergone dialysis for >6 months. Patients were divided into three groups: well-nourished patients (group 1), moderately malnourished patients (group 2) and severely malnourished patients (group 3). For each participant, clinical markers of malnutrition such as serum albumin and prealbumin were measured. Anthropometric measurements and a fasting lipid profile were taken and specific lipid ratios were assessed, as well as the AIP.Results: The mean age of our participants was 44.81 ± 14.01 years old. The most common lipid alteration recorded was increased non-HDL-C (88%) followed by decreased HDL-C (70%), and hypertriglyceridaemia (30%). Malnourished patients had a higher cardiovascular risk with AIP >0.21. We observed a significant decrease in lipid parameters parallel to the increasing severity of malnutrition increased. Group 3, had highly significantly lower values for serum albumin, serum prealbumin, Body mass index (p =0.0001) and non-HDL-C (p =0.01) than group 1. Group 2 presented significantly higher values compared to group 3 (p<0.0001) for albumin, prealbumin and non- HDL-C, and very significantly values (p <0.01) for BMI, LDL-C, HDL-C, TG, TC/HDL-C, non- HDL/HDL-C and AIP. Pearson’s correlation coefficients of lipid ratios showed greater values than those of lipids alone. AIP was positively correlated with lipid ratios and nutritional markers such as serum albumin and prealbumin.Conclusion: Our study is the first one in Morocco which confirms that Protein-energy wasting affects the serum lipoprotein profile of haemodialysis patients. Lipid ratios, especially atherogenic index of plasma, may be useful tools for diagnosing and assessing the risk of cardiovascular disease in malnourished haemodialysis patients.