부산대학교 도서관

Dsylipidemia is considered as a significant risk factor for progressive renal dysfunction in diabetic patients. Present study was designed with intent to compare two different statin agents with moderate dose intensity in preventing the progression of kidney dysfunction in diabetic patients among local population. Objective: To assess comparative effects of atorvastatin and rosuvastatin on renal functions in diabetic patients presenting to Pakistan Institute of Medical Sciences, Islamabad. Randomized controlled trial spanned at Six months (08-05-2018 to 07-11-2018) at Department of Nephrology and Internal Medicine, PIMS, Islamabad. Subjects and Methods: A total of one hundred and fifty six (n=156) diagnosed patients of diabetes mellitus with GFR >60 ml/min/1.73 m2 requiring statin treatment were enrolled in the present study. All the patients were randomly assigned to two groups by lottery method. Group A was given atorvastatin 10-20 mg/day and group B was given rosuvastatin 5-10 mg/day. The GFR was calculated using 24 hour urinary creatinine clearance at baseline and at six months after initiation of therapy. The study outcome was determined in terms of change in GFR values at six months in both groups. Treatment was considered efficacious if the decline in GFR at six months after therapy was <2% from baseline Results: Demographic features were similar in both groups. There were 65.4% (n=51/78) males and 34.6% (n=27/78) females in group A and there were 62.8% (n=49/78) males and 37.2% (n=29/78) females in group B. In group A, mean age was 40.8 years ± 7.6 SD, mean height was 1.6 m ± 0.06 SD, mean weight was 73.4 Kg ± 10.4 SD and mean BMI was 27.1 Kg/m² ± 4.2 SD. In group B, mean age was 41.2 years ± 7.2 SD, mean height was 1.7 m ± 0.06 SD, mean weight was 73.6 Kg ± 9.4 SD and mean BMI was 26.1 Kg/m² ± 4.1 SD. (p>0.05 in all cases). In group A, mean TG was 167.5 mg/dL ± 3.5 SD, mean total cholesterol was 219.1mg/dL ± 11.2 SD, mean HDL-C was 44.5 mg/dL ± 3.5 SD and LDL-C was 137.1 mg/dL ± 3.4 SD. In group B, mean TG was 166.5 mg/dL ± 4.5 SD, mean total cholesterol was 217.8 mg/dL ± 9.4 SD, mean HDL-C was 44.8 mg/dL ± 2.9 SD and LDL-C was 138.6 mg/dL ± 5.5 SD (p>0.05 in all cases). In group A, mean Hb was 12.9 g/dL ± 2.3 SD, mean HbA1c was 8.7% ± 0.94 SD, mean serum creatinine was 1.24 mg/dL ± 0.15 SD and mean GFR was 77.1 ml/min ± 10.9 SD. In group B, mean Hb was 13.4 g/dL ± 1.7 SD, mean HbA1c was 8.6% ± 1.02 SD, mean serum creatinine was 1.28 mg/dL ± 0.13 SD and mean GFR was 74.3 ml/min ± 10.4 SD. (p>0.05 in all cases). Six months after start of treatment lipid profile showed significant reductions in TG, total cholesterol and LDL-C in group A (Atrovastatin) when compared with group B (Rosuvastatin). Mean TG was 143.5 mg/dL ± 2.9 SD, versus 145.9 mg/dL ± 3.9 SD (P=0.001), mean total cholesterol was 187.7/dL ± 9.6 SD versus 190.9 mg/dL ± 8.2 SD (P=0.025) and mean LDL-C was 113.3 mg/dL ± 2.8 SD versus 117.3 mg/dL ± 4.6 SD (p=0.001) in group A and B respectively. Decline in GFR and mean percent change in GFR was significantly lower in group A (Atrovastatin) when compared with group B (Rosuvastatin). Mean GFR was 75.7 ml/min ± 10.8 SD, versus 72.7 ml/min ± 10.5 SD (P=0.007) and mean percent change in GFR was 1.81% ± 1.03 SD versus 2.27 ml/min ± 1.07 SD (P=0.004) in group A and B respectively. Efficacy was present in 52.6% (n=41/78) patients in atrovastatin group compared to 33.3% (n=26/78) in Rosuvastatin group (P=0.015). Efficacy data were further stratified with respect to gender, age, BMI and glycemic control. Efficacy of treatment was better in non obese patients with adequate glycemic control (P<0.05). Conclusions: Treatment with Atrovastatin resulted in significant improvement in lipid profile at six months after treatment when compared with Rosuvastatin. Mean decline in GFR at six months after therapy was significantly lesser with Atrovastatin compared with Rosuvastatin. Efficacy (<2% decline in GFR from baseline at six months after therapy) was significantly better with treatment with Atrovastatin compared to Rosuvastatin. Treatment response was better in non obese patients with adequate glycemic control. [ABSTRACT FROM AUTHOR]