dc.description.abstract | Background
Chronic kidney disease (CKD) is a worldwide public health problem. There is a
high prevalence of cardiovascular disease (CVD) in patients with CKD
contributed to by presence of both traditional and non-traditional cardiovascular
(CV) risk factors. Peripheral arterial disease (PAD) is a distinct atherothrombotic
syndrome that is associated with an elevated risk of cardiovascular and cerebral
events including myocardial infarction, stroke and death. The ankle-brachial
index (ABI) is a simple, non-invasive, inexpensive and reliable measurement to
assess the patency of the lower extremity arterial system with a sensitivity of
95% and specificity of 100%.
Objectives
The aim of the study was to determine the prevalence of PAD and the associated
cardiovascular risk factors among patients with CKD at the Kenyatta National
Hospital.
Design Imethods
Hospital based cross-sectional prevalence study
Setting
Kenyatta National Hospital Renal Clinic.
Subjects
Adult patients ~30 years with chronic kidney disease defined as proteinuria for ~3
months and or a GFR </= 60 ml/min/1.73 m2.
Outcome measures
• Prevalence of PAD.
• Prevalence of selected CV risk factors in patients with CKD and PAD: -
age, male gender, hypertension, cigarette smoking, dyslipidemia and
diabetes mellitus.
• Relationship between the selected CV risk factors and PAD.
• Proportion of patients with symptomatic PAD.
Results
Between January and October 2006, 194 patients with CKD were studied, 111
males and 83 females. The underlying aetiology of CKD was diabetes in 34%,
hypertension in 29%, chronic glomerulonephritis in 29%, obstructive uropathy in
6% and polycystic kidney disease in 2%. The mean GFR was 36 ± 24.7 (range
1.9 - 110.1 mllmin/1.73m2
) with 81.4% of the patients having advanced CKD.
Twenty-three patients had ABI <0.9 computing to a PAD prevalence of
r- 11.9%(95% CI, 7.3- 16.4). The mean age of PAD patients was significantly
higher than non-PAD counterparts (67.7 ±14.3yrs versus 50.5 ±13.6; p=O.OOO).
PAD patients had a worse renal function compared to non-PAD patients (GFR
27.2 ± 21 versus 37.3 ± 25 ml/min/1.73m2, p=0.04). All but five of the PAD
patients were male and all females were aged over 55yrs.
All the PAD-patients demonstrated presence of traditional CV risk factors with the
majority having more than two risk factors. The commonest risk factor was age
occurring in 87% followed by male gender 78%, hypertension 74%, diabetes
mellitus 56%, cigarette use 47% and dyslipidemia 43%.
The odds ratios for cigarettes use, male gender, diabetes mellitus and CKD
stage <3 versus CKD stage <3 were on average two fold, however only the male
gender and diabetes mellitus attained statistical significance. Hypertension and
dyslipidemia in this data set were not associated with the presence of PAD.
On basis of the Edinburgh Claudication Questionnaire, 47.8% of PAD patients
exhibited intermittent claudication.
Conclusions
The prevalence of PAD in CKD patients at KNH was 11.9%. All the selected CV
risk factors were prevalent in the PAD population in varying proportions. Of the
CV risk factors assessed, male gender and diabetes mellitus were independently
associated with PAD. More than half of the patients with PAD were
asymptomatic. | en_US |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |