Association between Triglyceride Serum Levels and Glomerular
Filtration Rate (eGFR) in Patients with Chronic Renal Failure at
Jemursari Islamic Hospital Surabaya, Indonesia
Uswatun Hasanah1, Suhariyadi2, Andreas Putro Ragil Santoso1
1

Department of Medical Laboratory
Technology, Faculty of Health,
Universitas Nahdlatul Ulama
Surabaya, Surabaya Indonesia
2

Departement of Medical
Laboratory Technology, Poltekkes
Kemenkes Surabaya, Surabaya,
Indonesia
Correspondence:
Uswatun Hasanah,
Jl. Jemursari No. 51-57, Surabaya,
East Java, Indonesia
Zip Code : 60237
Email:
uswatun.ankes15@gmail.com
Received: July 17, 2020
Revised: August 23, 2020
Accepted: August 25, 2020

Abstract
Chronic Renal Failure (CRF) is a progressive and
irreversible decrease in kidney function. One risk factor that
affects the progression of CRF is dyslipidemia due to
abnormalities of lipid metabolisms. Dyslipidemia is
characterized by the increase level of total cholesterol, LDL
cholesterol, triglycerides, and a decrease in HDL cholesterol
level. eGFR is a parameter for assessing the excretion
function, by calculating the amount of filtrate produced by
the renal glomerulus. This study aims to determine the
relationship between serum triglyceride levels with eGFR in
patient suffering from CRF at Jemursari Islamic Hospital
Surabaya. This type of research is descriptive experimental
with cross–sectional design. The study population was the
patients with CRF. The primary data in this study was the
results of examination of serum triglyceride levels in
patients with CRF. The secondary data (serum creatinine
levels, body weight, age, and sex) was obtained from
medical records of CRF patients in February 2019. As much
as 12% of patients were in the 40–50 years old category,
36% of patients were 51–60 years old, 44% of patients were
61–70 years old, and 8% of patients were 71–80 years old.
72% of patients were male. The mean triglyceride level was
146.68 mg/dL and the average eGFR was 19.86
mL/min/1.73m2. The relationships between triglyceride
levels and eGFR was carried out by the Spearman–rho test
where r value was –0.442 and 𝜌 value was 0.027. It was
concluded that there was a significant negative correlation
between serum triglyceride levels and eGFR in patients with
CRF.
Keywords
Chronic renal failure, triglycerides, eGFR, GPO–PAP

INTRODUCTION

general, there are 2 types of kidney failure,

Renal failure is a condition in which the

namely chronic renal failure and acute renal

kidney decrease the function, so the kidneys

failure. Acute renal failure is a condition in

are unable to maintain body homeostasis. In

which the kidneys suddenly stop functioning
50

Uswatun Hasanah, et al.

entirely or almost entirely but may still be

triglycerides begins with absorption in the

able to return to normal kidney function in a

intestine and it is circulated in the blood to the

short time. Meanwhile, chronic renal failure

liver

is a condition in which there is a progressive

(exogenous). The people who consume foods

damage to the function of many nephrons that

which high in lipids will cause the

have an effect on reducing the kidney

appearance of cloudy serum such as milk or

function. Both of those categories produce

cream (lipemic). The liver has a role in the

specific renal failure which results in renal

treatment of triglycerides. Most triglycerides

blood

tubules,

are stored as fat in adipose tissue. The

interstitial kidneys, and parts of the urinary

function of triglycerides is to provide energy

tract outside the kidney (1). Renal failure is

to the heart muscle and skeletal muscle as

defined as chronic if it is chronic, permanent,

well as to reserve of energy that can produce

and progressive, so that the glomerular

a lot of ATP. Triglycerides are a major cause

filtration rate (GFR) will progressively

of arterial disease and are often compared to

decrease and will eventually reach terminal

cholesterol

through

renal failure. Patients with chronic renal

electrophoresis

test.

failure (CRF) are often asymptomatic until

triglyceride

there is an increase in kidney damage (2).

hyperlipoproteinemia (4).

vessels,

glomerulus,

in

the

form

of

The

concentration

chylomicrons

lipoprotein
increase
will

in

cause

Based on data in various centers of

According to a study conducted by

nephrology in Indonesia, the prevalence of

Bhagaskara, et.al (5), the mean triglyceride

chronic renal failure increases with age. It

levels in patients with chronic renal failure

sharply increases in the age group of 35–44

was 163.26 mg/dL (it belongs to fairly high

years old (0.3%), followed by 45–54 years of

category). The results of this study are in

age (0.4%) and 55–74 years of age (0.5%).

accordance with Raju’s research, et.al (5),

The highest prevalence of chronic renal

which stated that chronic renal failure

failure are ≥75 years of age (0.6%). In

patients with dyslipidemia showed the

addition, the prevalence of CRF in men is

characteristics such as elevated triglyceride

0.3% which is higher than that of women

levels and LDL cholesterol levels (5).

(0.2%) (3).

Hyperlipidemia or an increase in lipid profile

Triglycerides

(also

contributes not only to heart disease, but also

triacylglycerol) are one of the fats in the

contributes to the progression of renal failure.

blood formed by esterification of glycerol

Glomerular Filtration Rate (GFR) is one

and three fatty acids carried by lipoproteins

of the physiological examinations of the

in plasma (4). The digestive process of

kidneys in assessing excretory function by

Ina J Med Lab Sci Tech 2020; 2(2): 50-59

51

called

Uswatun Hasanah, et al.

calculating the filtrate released by the

patients with CRF at Jemursari Hospital

glomerular kidney. Patients with GFR 60–89

Surabaya in February 2019.

mL/min/1.73m2 showed an increase in lipid

The study population was patients with

profile. According to Sengsuk(6) in the

chronic renal failure at the Jemursari Islamic

Diabetes and Obesity International Journal,

Hospital Surabaya in the period of February

the determination of GFR estimation was

2019 who had fulfilled the retention criteria

based on the Cockroft–Gault formula which

to be taken as research subjects. The sample

uses 3 variables (age, weight, and sex) with

used was fresh serum (fasting 12 hours),

the

90

which was obtained from whole blood

lipoproteins

without anticoagulants that was centrifuged

play a direct role in the pathogenesis of

at 3.000 rpm for ±15 minutes at room

glomerulosclerosis

temperature (12). The sample size was

normal

value

mL/min/1.73m2.

of

eGFR

Circulating

and

is

tubulointerstitial

changes (6).

calculated using Slovin formula and was

Based on the explanation above, the

resulted as many as 25 serum (8).

authors are interested in examining the

The research sample was taken using

Correlation of Triglyceride Serum Levels to

purposive sampling technique which was

Estimated Glomerular Filtration Rate (eGFR)

based on certain considerations that had met

in Patients with Chronic Renal Failure at

the inclusion criteria set by the researcher.

Jemursari Islamic Hospital Surabaya.

The sample inclusion criteria used in this
study were: patients with chronic renal
failure, men and women aged ≥40 years old,

MATERIALS AND METHODS

52

The

research

method

used

was

patients with chronic renal failure who were

descriptive experimental research with a

either

cross–sectional

The

hemodialysis, patients with chronic renal

equipment’s that used in this research were

failure who perform creatinine examination

TMS 24i Premium automatic device (Tokyo

and measurement of body weight in the same

Boeki

µl

time, and patients with chronic renal failure

micropipette, blue micropipette tip, and

who were undergoing hospitalization or

Eppendorf tube. The primary data in this

outpatient care. The exclusion criteria for the

study was the result of examination of serum

study sample included: patients aged <40

triglyceride levels in patients with chronic

years,

renal

CRF+hypertension, CRF+diabetes mellitus,

study

Medisys,

failure.

Japan),

Secondary

design.

10–1000

data

(serum

creatinine levels, body weight, age, and sex)

have

or

patients

have

with

not

a

undertaken

diagnosis

of

CRF+renal cysts, and CRF+urosepsis.

was obtained from medical records of
Ina J Med Lab Sci Tech 2020; 2(2): 50-59

Uswatun Hasanah, et al.

The samples obtained were centrifuged
at 3.000 rpm for ±15 minutes. The serum was

any time if they do not agree or are not
satisfied with any study procedures.

separated into eppendorf tubes. A total of 25
fresh serum samples were analyzed for

RESULTS

triglyceride levels using the GPO–PAP

Table 1 shows the distribution of samples

enzymatic colorimetric method using the

by age and gender. The age of the men and

automatic TMS 24i Premium (Tokyo Boeki

women respondents was ≥40 years. About

Medisys, Japan). Determination of eGFR

75% of respondents were outpatient care and

value was calculated manually using the

25%

Cockcroft–Gault (C–G) formula:

hospitalization. Most of CRF patients were

of

respondents

were

undergoing

61–70 years old (44%), followed by 12% of
𝐺𝐹𝑅 =

(140 − 𝑎𝑔𝑒) × 𝑤𝑒𝑖𝑔ℎ𝑡(𝑘𝑔) × 0,85(𝑓𝑒𝑚𝑎𝑙𝑒)
𝑚𝑔

72 × 𝑆𝑐𝑟 ( 𝑑𝐿 )

Scr : Serum creatinine

The results of the analysis of triglyceride
levels were carried out to invistigate the
correlation analysis of the eGFR value.
The variables in this study were age,
gender, triglyceride level, and eGFR of CRF
patients. The data were analyzed by
univariate and bivariate. Bivariate analysis
(eGFR and triglycerides) used the Spearman
correlation test with the data normality test.
Data is presented in textular, graphical and
tabular forms. The statistical program used is
IBM SPSS Statistics 23.0.
Ethical Clearance
This research was approved by the
Research Ethics Committee of Jemursari
Islamic Hospital Surabaya (005/KEPK–RSI
JS/I/2019). Involvement of respondents was
based on a written agreement by filling a

Ina J Med Lab Sci Tech 2020; 2(2): 50-59

36% of patients falls in 51–60 years age
group and 8% of patients were categorized in
71–80 years age group. Table 2 shows the
distribution

of

samples

according

to

laboratory examination results. The eGFR
results was calculated manually using the
Cockcroft–Gault

formula.

The

variable

serum creatinine levels, body weight, age,
and sex data were obtained from medical
records of patients in February 2019. Based
on the Table 2, there were 0% of CRF
patients with eGFR values between 60–89
and ≥90 mL/min/1.73m2. A total of 5 stage
III patients (20%) have eGFR values 30–59
mL/min/1.73m2. Ten stage IV patients (40%)
have eGFR values 15–29 mL/min/1.73m2
and 10 stage V patients (40%) have eGFR
values <15 mL/min/1.73m2. The mean eGFR
value was 19.87 with standard deviation
11.41.
All

of

dyslipidemia.

respondents
There

suffered

were

64%

from
of

53

consent form. Respondents may withdraw at

patients belongs to 40–50–years age group,

Uswatun Hasanah, et al.

respondents have triglyceride level <150

have TG level 200–499 mg/dL. The mean

mg/dL. Four patients (16%) have triglyceride

triglyceride level was 146.68 with standard

level of 150–199 mg/dL and 5 patients (20%)

deviation 86.95.

Table 1. Sample Distribution by Gender and Age
Gender

Aged

Male

40–50
51–60
61–70
71–80
40–50
51–60
61–70
71–80

Female

Additional Inspection
Weight (kg)
Scr (mg/dL)
53
5.54
61–78
1.49–18.28
61–78
1.76–9.93
68–74
1.79–2.48
48–51
1.79–6.01
49–51
1.45–7.12
50–53
3.70–9.74
0
0

Hemodialysis
(HD)
Non–HD
Non–HD
Non–HD
Non–HD
Non–HD
Non–HD
Non–HD
Non–HD

%
4%
28%
32%
8%
8%
8%
12%
0%

Table 2. Sample Distribution According to Laboratory Examination Results
Laboratory Test

Range

Mean

Std. Dev.

%

eGFR (mL/min/1.73m2)

≥90
60–89
30–59
15–29
≤15
<150
150–199
200–499
≥500

19.87

11.41

146.68

86.95

0%
0%
20%
40%
40%
64%
16%
20%
0%

54

Triglyceride (mg/dL)

Figure 1 shows the data distributions of

maximum value was 357 mg/dL. While, the

triglyceride levels in patient with CRF.

results of the eGFR value were a minimum

Kolmogrov–Smirnov Normality Test shows

value 4.75 mL/min/1.73m2 and a maximum

that the distribution was normal (𝜌<0.05).

value

Figure 2 shows the data distributions of

statistical

eGFR, which were normal (𝜌<0.05).

triglyceride levels and eGFR can be seen in

of

47,76

mL/min/1.73m2.

correlations

between

The
serum

Table 3 shows the statistical distribution

Table 4. The Spearman–rho correlation test

of triglyceride and eGFR. It shows the results

results obtained significance value 0.027 < α

of examination of triglyceride levels (a

(0.05).

minimum value was 33 mg/dL and a
Ina J Med Lab Sci Tech 2020; 2(2): 50-59

Uswatun Hasanah, et al.

6

5

4

3

2

1

0
0

100

200

400

300

Fig 1. Distributions of Triglyceride Levels (mL/min/1.73m2)

5

4

3

2

1

0
.00

10.00

20.00

30.00

40.00

50.00

Fig 2. Distributions of eGFR (mg/dL)

Table 2. Min–Max and Median Values of TG and eGFR
Value’s Range Min–Max
33–357 mg/dL
4.75–47.76 mL/min/1.73m2

Laboratory Test
TG
eGFR

Median
123 mg/dL
15.59 mL/min/1.73m2

Table 3. Statistical Correlations
Triglyceride Levels

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eGFR
–.442*
.027
25

55

Correlation coefficient
Sig. (2–tailed)
N

Uswatun Hasanah, et al.

progressive decrease in GFR and Renal

DISCUSSION
This study aims to determine the

Blood Flow (RBF). The decrease occurs

correlation between serum triglyceride levels

around 8 mL/min/1.73m2 per decade since

and eGFR values in subjects with chronic

the 40 years of age (9).

renal failure. The population of this study

Of 25 samples, 18 patients (72%) were

were all patients with chronic renal failure at

male, while 7 patients (28%) were. This is in

Jemursari Islamic Hospital in Surabaya

accordance with the Indonesian Renal

during February 2019. The number of

Registry (9) data, which shown hemodialysis

patients with CRF was 93 patients, but only

patients

25 patients met the inclusion criteria. A total

dominated by men in 2007–2012 (10). These

of 8 excluded patients were under 40 years

results might be related to the incidence of

old. Moreover, 60 excluded patients had a

CRF, such as kidney stones, which also occur

diagnosis of CRF with complications. The

mostly in male. Other studies show that the

results showed that 40% of respondents was

prevalence of kidney stones in men was

stage IV CRF patients, 40% of respondents

10,6% and those in women was 7,1%.

Indonesia

were

was stage V patients, followed by 20% of

Based on Table 2, that was 0% of CRF

stage III patients, 0% of respondents was

patients who has eGFR values between 60–

stage I and II patients. The degree of severity

89 and ≥90 mL/min/1.73m2. A total of 5 stage

is obtained through the calculation of the

III patients (20%) has eGFR values 30–59

eGFR value with Cockcroft–Gault (C–G)

mL/min/1.73m2. Ten stage IV patients (40%)

mL/min/1.73m2.

is

has eGFR values of 15–29 mL/min/1.73m2

parameter for assessing excretion function,

and 10 stage V patients (40%) has eGFR

by measuring the amount of filtrate produced

values <15 mL/min/1.73m2. A decrease in

by the kidney glomerulus (2). The lower

GFR value can be affected by the increasing

value of GFR indicates the more severity of

age and the cause of kidney damage itself.

formula

in

GFR

the kidney damage.

56

throughout

Based on Table 2, the results of

Table 1 shows that the most respondents

examination of triglyceride levels were a

(44%) with CRF occur at 61–70 years of age.

minimum value of 33 mg/dL, a maximum

12% of respondents was in the 40–50–year

value of 357 mg/dL, and a mean of 146,68

age group, 36% of respondents was in the 51–

mg/dL. While the results of the eGFR value

60–year age group and 8% of them was in the

obtained

71–80–year age group. A decline in kidney

mL/min/1.73m2, a maximum value of 47,76

function is a normal process as the age

mL/min/1.73m2 with an average 19,86

increase. The increasing age shows a

mL/min/1.73m2. The results of the study at

a

minimum

value

4,75

Ina J Med Lab Sci Tech 2020; 2(2): 50-59

Uswatun Hasanah, et al.

the Laboratory Unit at Jemursari Islamic

the higher the eGFR value will be. This

Hospital Surabaya stated that there was a

mismatch may be caused by several factors,

relationship between triglyceride levels and

such as a high creatinine diet, malnutrition,

eGFR

The

ketoacidosis and drugs (cimetidine, sulfa,

Spearman–rho correlation test results has a

trimethoprim) which results in decreased

significance value (0.027) < α (0.05) then H1

creatinine secretion which indicates as one of

was accepted, which means that there was a

the determinants of the glomerular filtration

statistically significant correlation between

rate (12).

values

in

CRF

patients.

serum triglyceride levels and eGFR values.

Indonesian Renal Regulations (IRR) data

The number of correlation coefficients is

stated that in 2007 there were 6,862 people

negative, which is –0.444 *. A negative sign

who suffered from chronic kidney failure and

indicates that the correlation of the two

experienced an increase in 2012, amount to

variables is not in the same direction (the type

28,782 people. Chronic kidney failure is

of relationship is not unidirectional). While

kidney damage that occurs for 3 months,

the asterisk (*) shows the level of strength

based on pathological abnormalities or

(closeness) of the relationship between the

markers

two variables (Table 4). Thus, it can be

proteinuria. If there is no sign of kidney

concluded that there was a strong and

damage, the diagnosis of CRF can be made if

unidirectional significant correlation between

the glomerular filtration rate is less than 60

the variables of triglyceride levels and eGFR

mL/min/1.73m2 (10). Decreasing the GFR

values. The higher the serum triglyceride

value is related to the severity.

level, the lower the eGFR value.

The

of

kidney

National

damage

Kidney

such

as

Foundation

Furthermore, 11 subjects had high

recommends that the eGFR can be calculated

triglyceride levels. This is in accordance with

according to serum creatinine. Calculation of

the research conducted by Anggun (16) in

GFR based on serum creatinine, age, body

Kariadi Hospital Semarang, where 73

size, gender, and race without the need for

patients with chronic renal disease were

urinary creatinine levels using the Cockcroft

accompanied by hypertriglyceride (52.9%).

and Gault equation (13). The classification of

Whereas, Senge, et al. (17) in the Kidney–

CRF stage based on GFR values is as follows:

Hypertension Polyclinic of RSUP Dr. R. D.

stage

Kandou Manado, found that there was a

mL/min/1.73m2, stage II with a GFR value of

positive relationship between triglyceride

60–89 mL/min /1,73m2, stage III with a GFR

levels and eGFR in CKD patients (ρ = 0.030),

value amounting to 30–59 mL/min/1.73m2,

meaning that the higher triglyceride levels,

stage IV with a GFR value of 15–29

with

a

GFR

value

of

90

57

Ina J Med Lab Sci Tech 2020; 2(2): 50-59

I

Uswatun Hasanah, et al.

mL/min/1.73m2, and stage V with a GFR of

will be absorbed as free fatty acids while

15 mL/min/1,73 m2 (14).

cholesterol remains cholesterol (4).

One

risk

factor

the

Inside the small intestine, free fatty acids

progression of chronic renal failure is

will be converted into triglycerides, while

dyslipidemia. People with CRF are at an

cholesterol will be esterified to cholesterol

increased risk of cardiovascular disease and

esters and both together with phospholipid

have a higher prevalence of hyperlipidemia

and apolipoproteins will form lipoprotein,

(or

general

known as chylomicron. This chylomicron

population. Dyslipidemia occurs due to

will enter the lymph channels and eventually

abnormalities of lipid metabolism in patients

through the thoracic duct will enter the

with CRF. Most of patients (47%) with

bloodstream. Triglycerides in chylomicron

chronic

from

will undergo hydrolysis by the lipoprotein

cardiovascular disease as the main cause

lipase enzyme derived from endothelium into

(10). In fact, mild renal insufficiency has

free fatty acids. Free fatty acids can be stored

been shown to be associated with an

as triglycerides again in fat tissue, but if they

increased rate of cardiovascular events (15).

are present in large amounts, some of them

Dyslipidemia characterized by increased

will be taken by the liver to become a

triglyceride levels, total cholesterol and LDL

material for the formation of triglycerides in

cholesterol and decreased HDL cholesterol

the liver (17).

dyslipidemia)

kidney

that

than

failure

affects

the

died

levels are often associated with CRF and
contribute

to

an

increased

risk

High triglyceride levels contribute to the

of

process of atherosclerosis. Poor circulation to

cardiovascular disease. Various experimental

most organs causes hypoxia and tissue injury,

studies have shown that lipid abnormalities

and stimulates inflammatory reactions in the

can worsen the progression of kidney damage

walls of blood vessels. If atherosclerosis

(17).

occurs, the blood supply to the kidneys will

The process of forming triglycerides is
derived from food. The fatty foods we eat

decrease and can cause GFR abnormalities
and decreased kidney function (17).

consist of triglycerides and cholesterol. In
addition to cholesterol derived from food, in

58

the intestine, there is also cholesterol from the

CONCLUSIONS
In conclusion, there was a significant

liver which is excreted with bile into the

negative

small intestine. Triglycerides and cholesterol

triglyceride levels and the estimated value of

in the small intestine will be absorbed into the

the Glomerular Filtration Rate (eGFR) in

intestinal mucosal enterocytes. Triglycerides

patients with chronic renal failure at

correlation

between

serum

Ina J Med Lab Sci Tech 2020; 2(2): 50-59

Uswatun Hasanah, et al.

Jemursari Islamic Hospital, Surabaya. The

CONFLICT OF INTEREST

higher the triglyceride level, indicate the
lower the eGFR value. Further research is

The authors declare no conflict of
interest.

needed to be done by considering the etiology
and clinical picture of CRF patients which are

ACKNOWLEDGMENT(S)

confounding factors in this study.

Appreciation goes to all respondents and
Management of Laboratory Unit, Jemursari
Islamic Hospital Surabaya who gave the
commitment

that

this

study

can

be

implemented successfully.

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