Evaluating the Relationship Between Nitric Oxide, Lipid Profile and Cardiovascular Risk in Chronic Kidney Disease: A Cross-sectional Study

Abstract

Background: Chronic kidney disease (CKD) is strongly linked to increased cardiovascular risk, primarily due to endothelial dysfunction (ED) and accelerated atherosclerosis. A major factor contributing to ED is reduced nitric oxide (NO) bioavailability, often resulting from heightened oxidative stress in CKD. As NO plays a critical role in maintaining vascular integrity, its deficiency may exacerbate both renal and cardiovascular complications. This study aimed to assess the association between serum NO levels, lipid profile, and cardiovascular risk in CKD patients.

Materials and Methods: A total of 220 individuals participated in this case-control study, comprising 110 CKD patients [75 males (68.18%), 35 females (31.81%)] and 110 age- and sex-matched healthy controls. Serum NO levels were determined using the Griess reaction method. Biochemical analyses included measurements of urea, creatinine, total cholesterol, triglycerides, HDL-C, LDL-C, and VLDL-C. Cardiovascular risk was evaluated  using the cardiac risk ratio. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. Statistical analyses were performed using SPSS version 30.0.

Results: CKD patients exhibited significantly higher levels of urea, creatinine, TC, TG, LDL-C, VLDL-C, and cardiac risk ratio as compared to controls (p < 0.001). In contrast, HDL-C and NO levels were significantly lower in the CKD group (p < 0.001). NO levels showed a positive correlation with eGFR and a negative correlation with creatinine, indicating a link between reduced NO levels and worsening renal function. No significant associations were observed between NO and lipid profile parameters.

Conclusion: The findings suggest that CKD is associated with significant dyslipidemia and reduced  nitric oxide levels, both of which may contribute to increased cardiovascular risk. The observed relationships between NO and renal function markers highlight the potential utility of NO as a biomarker for endothelial dysfunction in CKD patients..