Evaluation of serum cystatin-C, Myeloperoxidase and other biochemical markers for the early detection of renal failure in diabetic and non-diabetic patients in Karimnagar, Telangana.

Abstract

Aim and Objectives: The present study is undertaken to assess the role of serum cystatin-C, Myeloperoxidase, serum creatinine, urine albumin-creatinine ratio and microalbumin for the early diagnosis of chronic kidney disease in diabetics and non-diabetics in and around Karimnagar, Telangana. The objective was to evaluate whether combining serum creatinine, cystatin-C and urine albumin to creatinine ratio would improve the identification of risks associated with chronic kidney disease compared to creatinine alone in diabetic and non-diabetic patients and also to establish the possible mechanism of the role of Myeloperoxidase for the early diagnosis of Chronic kidney disease. Material and Methods: In the present cross sectional study, a total of 150 participants were included in the study. Group-1 comprises of 50 Normal healthy subjects, Group-2 comprises 50 Chronic Kidney Disease Patients without Diabetes Mellitus (CKD-ND) and Group-3 comprises 50 patients of Chronic Kidney Disease with Diabetes Mellitus (CKD-DM). The biochemical parameters were recorded in the samples collected from all participants of the study using Transasia XL-640 fully automated analyser. Myeloperoxidase was estimated by using ELISA reader. eGFR was calculated by applying the values of serum creatinine and cystatin-C in CKD- EPI creatinine and cystatin-C equation (2012). The results were analyzed with appropriate statistics using SPSS version 20.0 software. Results: Serum cystatin-C and serum creatinine were considerably increased in non diabetic subjects with CKD, and a notable reduction in eGFR levels was observed in Group-2 in comparison to Group-3. A significant negative correlation was observed between cystatin-C and eGFR between the groups. The strength of correlation of serum cystatin-C with eGFR was strong in Group-2 and Group-3 in comparison to controls. The values of Myeloperoxidase were decreased in diabetic patients with chronic kidney disease (Group-3) when compared with non- diabetic patients with chronic kidney disease (Group-2). Myeloperoxidase levels were compared with urea, creatinine, microalbumin and eGFR levels. eGFR levels showed a significant negative correlation with MPO levels. Conclusion: Serum cystatin-C can be used as an alternate marker to creatinine in patients with CKD. Diagnostic accuracy is favorable for serum cystatin-C when compared with serum creatinine in patients with decreased renal function. However, it is more sensitive for the estimation of eGFR than serum creatinine. Serum MPO levels can be used as an indicator for CKD patients with diabetes mellitus in assessing the renal impairment and to prevent further complications.