Cardiovascular risk factors and cardiac diseases among patients with chronic kidney disease attending the nephrology outpatient clinic in Mulago hospital

Abstract

Introduction: Chronic Kidney Disease (CKD) is a risk factor for development of cardiac and other cardiovascular diseases. Cardiovascular diseases are the primary cause of morbidity and mortality in patients with CKD. Local data about cardiac disease among CKD patients is generally scanty. Objective: To describe the cardiovascular risk factors and cardiac diseases among patients with CKD attending the nephrology outpatient clinic in Mulago hospital Methods: This was a cross sectional descriptive study. It was done in the Nephrology outpatient clinic of Mulago national referral hospital of Uganda. Consecutive patients with CKD, above eighteen years of age were recruited into the study. Patients on any form of renal replacement therapy were excluded. Demographic and clinical data were collected using a standardized pretested questionnaire. Blood samples were obtained for complete blood count and renal function tests/electrolytes and lipid profiles. Twelve lead resting ECG and echocardiography were performed for all study participants for the evaluation of cardiac structure and function. Data collected was entered into epidata 3.1 and final analysis done using STATA. Results: Two hundred seventeen patients with a mean age of 42.8years were recruited into the study. One hundred eleven (51.2%) of the participants were male. Majority of the study participants (111, 51.2%) were in end stage renal disease with 18.9% in stage four and 20.3% in stage three. A smaller proportion of patients (including 5.5% in stage two and 4.2% in stage one) were in the earlier stages of CKD. One hundred eighty four patients (84.8%) had proteinuria and 14.8%% were HIV positive. Hypertension was present in 88% of study participants, 10.2% were obese, while 16.1% were diabetic. One hundred eighteen (54.4%) of patients had either eccentric or concentric LVH. Patients with LVH were more likely to be hypertensive (p <0.001) or anemic (p = 0.034). Up to 9.2% of study subjects had valvular heart disease (rheumatic or degenerative) and 22% had pericarditis. Forty one patients (18.9%) had left ventricular systolic failure (EF < 50%). There was a higher prevalence of systolic failure in patients with LVH (21% vs. 16%) although this was not statistically significant, p = 0.346. Thirty eight participants (17.5%) had diastolic failure while 2% had cardiac rhythm abnormalities. Conclusion: This study has demonstrated that both traditional and nontraditional cardiovascular risk factors as well as abnormalities of cardiac structure and function occur frequently in patients with CKD attending the nephrology outpatient clinic in Mulago hospital.