Serum apolipoproteins (apoA-1, apoB and apoB/apoA-1 ratio) for early identification of dyslipidemia in children with CKD

Abstract

Abstract Background Dyslipidemia in children with chronic kidney disease (CKD) is identified based on lipid profile parameters; however changes in lipoprotein quality precede quantitative changes. Aims and Objectives The primary objective of the study was to determine prevalence of dyslipidemia and estimate levels of apoB, apoA-1 and ratio of apoB/apoA-1 in children and adolescents (2-18 years) with CKD (all stages). Methods A cross-sectional study was done from January-October 2021; overweight, obese children, known cases of diabetes mellitus, hypothyroidism or on steroid therapy or lipid lowering drugs were excluded. Clinical details were elicited and examination done. Besides hemogram, kidney function tests, liver function tests, Total cholesterol, Low density lipoprotein (LDL), triglycerides, high density lipoprotein (LDL), apolipoproteins A-1 and B were estimated to identify dyslipidemia. Relevant tests of significance were applied and ROC curves were drawn for apoA-1, apoB and apoB/apoA-1 ratios. Results 76 (61M: 15 F) children with median (IQR) age 7 (3.25-11) years were enrolled; cause of CKD was CAKUT in 82.3% patients. Dyslipidemia was seen in 78.9% with a prevalence of 71.7% in early and 95.7% in later stages of CKD (P=0.02). The median (IQR) values of apoB, apoA-1, and apoB/apoA-1 ratio were 78(58-110) mg/dl, 80(63-96.75) mg/dl, 0.88 (0.68-1.41) respectively; apoB, apoA-1 and apoB/apoA-1 ratio had a sensitivity of 26.67%, 86.67% and 70% and specificity of 87.5%, 62.5%, 62.5% respectively for diagnosis of dyslipidemia. The ROC for apoB, apoA-1 and apoB/apoA-1 ratio showed AUC of 0.66, 0.68, 0.74 (P= 0.4, 0.02, <0.01) respectively. Conclusions The prevalence (78.9%) of dyslipidemia was high in patients with CKD especially in those with later stages. The ratio of apoB/apoA-1 was altered early and appears to be promising for early detection.